Organization
ST LOUIS KIDNEY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN VALLE (PRESIDENT)
(781) 699-9362
Entity
Organization
Contact information
Practice address
1265 GRAHAM RD STE 1, FLORISSANT, MO 63031-8018
(314) 741-1600
(314) 741-1677
Mailing address
1265 GRAHAM RD STE 1, FLORISSANT, MO 63031-8018
(314) 741-1600
(314) 741-1677
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
455247262-04915-01
—
IL
05
—
500035811
—
MO
Enumeration date
11/13/2015
Last updated
07/24/2024
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