Healthcare Provider Details

I. General information

NPI: 1912381005
Provider Name (Legal Business Name): SAINT LUKES RADIATION THERAPY-LIBERTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2529 GLENN HENDREN DR SUITE G40
LIBERTY MO
64068-9606
US

IV. Provider business mailing address

901 E 104TH ST SUITE 900
KANSAS CITY MO
64013-3497
US

V. Phone/Fax

Practice location:
  • Phone: 816-251-5630
  • Fax:
Mailing address:
  • Phone: 816-932-2337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number4885
License Number StateMO

VIII. Authorized Official

Name: AMY M NACHTIGAL
Title or Position: CFO
Credential:
Phone: 816-932-2000