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Organization

METRO ST. LOUIS DIALYSIS - FLORISSANT LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KEISHA DENISE GREENE (VP OF CLINICAL & REGULATORY)
(978) 522-3905
Entity
Organization

Contact information

Practice address
10160 W FLORISSANT AVE, SAINT LOUIS, MO 63136-2104
(314) 869-4978
(314) 869-5098
Mailing address
10160 W FLORISSANT AVE, SAINT LOUIS, MO 63136-2104
(314) 869-4978
(314) 869-5098

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
506121102
MO
Enumeration date
12/18/2006
Last updated
08/18/2022
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