PD Nephrology LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

LC0921675 Issued in MO

Legal business name

PD NEPHROLOGY LLC

Practice address

10004 Kennerly Rd
Suite 103a
Saint Louis, MO 63128-2173

Phone

(314) 543-5235

Fax

(314) 543-5216

NPI assigned

Oct 3, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Nabil Tauk, M.D.

Title

Medical Director

Phone

(314) 543-5235

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1222992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235433600000",
    "number": "1942451380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10004 KENNERLY RD",
            "address_2": "SUITE 103A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282173",
            "telephone_number": "314-543-5235",
            "fax_number": "314-543-5216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10004 KENNERLY RD",
            "address_2": "SUITE 103A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282173",
            "telephone_number": "314-543-5235",
            "fax_number": "314-543-5216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PD NEPHROLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-03",
        "last_updated": "2009-02-24",
        "status": "A",
        "authorized_official_last_name": "TAUK",
        "authorized_official_first_name": "NABIL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "314-543-5235",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "MO",
            "license": "LC0921675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney Payton, PHARMD
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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2009; 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.