Healthcare Provider Details

I. General information

NPI: 1457343634
Provider Name (Legal Business Name): BALLAS CANCER CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N NEW BALLAS RD SUITE 270
SAINT LOUIS MO
63141-6835
US

IV. Provider business mailing address

450 N NEW BALLAS RD SUITE 270
SAINT LOUIS MO
63141-6835
US

V. Phone/Fax

Practice location:
  • Phone: 314-989-1300
  • Fax:
Mailing address:
  • Phone: 314-989-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberR5P45
License Number StateMO

VIII. Authorized Official

Name: DR. RACHEL A BORSON
Title or Position: EXECUTIVE MANAGER
Credential: M.D.
Phone: 314-989-1300