Organization
GATEWAY ST LOUIS DIALYSIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARA ANNE BRADY (CHIEF NURSING OFFICER)
(208) 371-7878
Entity
Organization
Contact information
Practice address
4100 UNION BLVD, SAINT LOUIS, MO 63115-1225
(314) 382-3480
(314) 382-3515
Mailing address
4100 UNION BLVD, SAINT LOUIS, MO 63115-1225
(314) 382-3480
(314) 382-3515
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149774520
—
MO
Enumeration date
05/28/2010
Last updated
01/10/2023
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