Healthcare Provider Details

I. General information

NPI: 1386960110
Provider Name (Legal Business Name): HEARTLAND CLINIC CANCER CENTER ST JOSEPH ONCOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N 6TH ST SUITE 15
ATCHISON KS
66002-2416
US

IV. Provider business mailing address

902 N RIVERSIDE RD SUITE 200
SAINT JOSEPH MO
64507-2559
US

V. Phone/Fax

Practice location:
  • Phone: 913-367-9175
  • Fax: 913-367-9563
Mailing address:
  • Phone: 816-271-1301
  • Fax: 816-271-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number0423186
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. JULIE A CUSICK
Title or Position: OFFICE MANAGER
Credential:
Phone: 816-271-1301