NPIMap

Organization Active NPI

Metro Saint Louis Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Saint Louis, MO
National Provider Identifier
1407916653
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
LC0062653 Issued in MO
Legal business name
METRO SAINT LOUIS DIALYSIS CENTER
Practice address
10160 W Florissant Ave
Saint Louis, MO 63136-2104
Phone
(314) 869-4978
Fax
(314) 869-5245
NPI assigned
Dec 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bhanjalal Dara, M.D.
Title
Medical Director
Phone
(314) 869-4978

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X LC0062653 MO Primary

Addresses

Primary practice location

10160 W Florissant Ave
Saint Louis, MO 63136-2104

Mailing address

10160 W Florissant Ave
Saint Louis, MO 63136-2104
Phone (314) 869-4978

Other identifiers 4

IdentifierTypeStateIssuer
167804OtherMOHEALTHLINK
189912OtherMOGROUP HEALTH PLAN
5000123OtherMOUNITEDHEALTHCARE
179188OtherMOBCBS OF MISSOURI

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407916653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10160 W FLORISSANT AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631362104",
            "telephone_number": "314-869-4978",
            "fax_number": "314-869-5245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10160 W FLORISSANT AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631362104",
            "telephone_number": "314-869-4978",
            "fax_number": "314-869-5245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METRO SAINT LOUIS DIALYSIS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DARA",
        "authorized_official_first_name": "BHANJALAL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "314-869-4978",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "MO",
            "license": "LC0062653",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "167804",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH PLAN",
            "identifier": "189912",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITEDHEALTHCARE",
            "identifier": "5000123",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MISSOURI",
            "identifier": "179188",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.