Healthcare Provider Details

I. General information

NPI: 1891946349
Provider Name (Legal Business Name): MERCY CLINIC ST. LOUIS CANCER AND BREAST INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD STE 260A
SAINT LOUIS MO
63141-8256
US

IV. Provider business mailing address

15945 CLAYTON RD SUITE 120
BALLWIN MO
63011-2490
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-8001
  • Fax: 314-256-5043
Mailing address:
  • Phone: 636-256-5000
  • Fax: 314-989-1323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State

VIII. Authorized Official

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