# ST LOUIS KIDNEY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114344348
- **Authorized official:** DR. JAY SELTZER M.D. (AUTHORIZED MEMBER)
- **Authorized official phone:** (314) 825-0361

## Contact information

- **Practice address:** 12855 N 40 DR, SUITE 205, SAINT LOUIS, MO 63141-8657
- **Practice address phone:** (314) 720-0900
- **Practice address fax:** (314) 579-0108
- **Mailing address:** 12855 N 40 DR, SUITE 205, SAINT LOUIS, MO 63141-8657
- **Mailing address phone:** (314) 720-0900
- **Mailing address fax:** (314) 579-0108

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/26/2014
- **Last updated:** 03/26/2014