Organization
METRO SAINT LOUIS DIALYSIS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BHANJALAL DARA M.D. (MEDICAL DIRECTOR)
(314) 869-4978
Entity
Organization
Contact information
Practice address
10160 W FLORISSANT AVE, SAINT LOUIS, MO 63136-2104
(314) 869-4978
(314) 869-5245
Mailing address
10160 W FLORISSANT AVE, SAINT LOUIS, MO 63136-2104
(314) 869-4978
(314) 869-5245
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
LC0062653
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
167804
HEALTHLINK
MO
01
—
179188
BCBS OF MISSOURI
MO
01
—
189912
GROUP HEALTH PLAN
MO
01
—
5000123
UNITEDHEALTHCARE
MO
Enumeration date
12/11/2006
Last updated
08/22/2020
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