Basic Information
| Provider Information | |||||||||
| NPI: | 1902834609 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WASHINGTON UNIVERSITY SCHOOL OF MEDICINE | ||||||||
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| OtherOrganizationName: | FARMINGTON DIALYSIS CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7425 FORSYTH BLVD | ||||||||
| Address2: | CAMPUS BOX 8221 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631052171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149350770 | ||||||||
| FaxNumber: | 3149350575 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 NORTH A ST | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737608040 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 09/24/2007 | ||||||||
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| AuthorizedOfficialLastName: | EGHIGIAN | ||||||||
| AuthorizedOfficialFirstName: | CATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR, CREDENTIALING OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 3149350770 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
No ID Information.