MEDICARE: STL INTERVENTIONAL ONCOLOGY INTERVENTIONAL RADIOLOGY CLINICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0204X	Vascular & Interventional Radiology Physician

General Provider Information

NPI Number	:	1558240960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STL INTERVENTIONAL ONCOLOGY INTERVENTIONAL RADIOLOGY CLINICS LLC

Provider Business Mailing Address
First Line	:	641 N NEW BALLAS RD
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6713
Country	:	US
Telephone Number	:	314-888-4647
Fax Number	:	314-514-4014

Provider Business Practice Location Address
First Line	:	641 N NEW BALLAS RD
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6713
Country	:	US
Telephone Number	:	314-785-4647
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MS. DONNA LOOSER
Credential	:
Telephone Number	:	314-894-3800

Provider Enumeration Date	:	08/29/2025
Last Update Date	:	01/14/2026

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