Healthcare Provider Details

I. General information

NPI: 1457395758
Provider Name (Legal Business Name): RADIATION ONCOLOGISTS OF NORTHWEST MISSOURI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 N RIVERSIDE RD
SAINT JOSEPH MO
64507-2566
US

IV. Provider business mailing address

POB 802818
KANSAS CITY MO
64180-0001
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-7280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT JOHNSON
Title or Position: DIRECTOR
Credential:
Phone: 816-271-7280