Organization
PREMIER DIALYSIS OF FERGUSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HAROLD GOLDAMMER JR. (PRESIDENT)
(618) 407-2153
Entity
Organization
Contact information
Practice address
800 CHAMBERS RD, FERGUSON, MO 63135-2133
(314) 522-8100
(314) 524-7826
Mailing address
132 FOX HILL CT, EDWARDSVILLE, IL 62025-5736
(618) 407-2153
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
—
504605403
—
MO
Enumeration date
01/29/2007
Last updated
12/10/2008
Update your record
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