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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
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