Organization
ST. LOUIS NEPHROLOGY AND HYPERTENSION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HENRY E PURCELL M.D. (PRESIDENT)
(314) 276-7664
Entity
Organization
Contact information
Practice address
2102 VADALABENE DR, MARYVILLE, IL 62062-5632
(618) 288-1196
Mailing address
PO BOX 797021, SAINT LOUIS, MO 63179-7000
(314) 644-3535
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
R9H62
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DG8471
RAILROAD MEDICARE
MO
Enumeration date
11/01/2006
Last updated
09/10/2024
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