Provider Demographics
NPI:1902500630
Name:ST LOUIS MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:ST LOUIS MEDICAL ASSOCIATES LLC
Other - Org Name:OZARK NEPHROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAGHUVEER
Authorized Official - Middle Name:
Authorized Official - Last Name:KURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-224-6625
Mailing Address - Street 1:1302 WILDHORSE MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-4493
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2651 SHELBY ROAD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-9998
Practice Address - Country:US
Practice Address - Phone:573-843-8380
Practice Address - Fax:573-843-8381
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. LOUIS MEDICAL ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-28
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty