Healthcare Provider Details

I. General information

NPI: 1932156726
Provider Name (Legal Business Name): ST. LOUIS CANCER CARE, L.L.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10004 KENNERLY RD STE 137A
SAINT LOUIS MO
63128-2140
US

IV. Provider business mailing address

10004 KENNERLY RD STE 137A
SAINT LOUIS MO
63128-2140
US

V. Phone/Fax

Practice location:
  • Phone: 314-842-7301
  • Fax: 314-842-7308
Mailing address:
  • Phone: 314-842-7301
  • Fax: 314-842-7308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberR1C00
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number103666
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberR7758
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberR6F58
License Number StateMO
# 5
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2002002867
License Number StateMO

VIII. Authorized Official

Name: CAROL J RILEY
Title or Position: PRACTICE MANAGER
Credential: RN BSN
Phone: 314-965-6411