Healthcare Provider Details

I. General information

NPI: 1407066343
Provider Name (Legal Business Name): MERCY CLINIC CHILDREN'S CANCER & HEMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 S NEW BALLAS RD SUITE 2415
CREVE COEUR MO
63141-8219
US

IV. Provider business mailing address

607 S NEW BALLAS RD SUITE 2415
CREVE COEUR MO
63141-8219
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6986
  • Fax: 314-251-5712
Mailing address:
  • Phone: 314-251-6986
  • Fax: 314-251-5712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: KERRY DUNGER
Title or Position: EXECUTIVE DIRECTOR - FINANCE
Credential:
Phone: 314-364-3707