Healthcare Provider Details

I. General information

NPI: 1023425329
Provider Name (Legal Business Name): ST. ANTHONY'S PHYSICIAN ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 KENNERLY RD ATTN: CANCER CARE CENTER
SAINT LOUIS MO
63128-2106
US

IV. Provider business mailing address

10010 KENNERLY RD ATTN: CANCER CARE CENTER
SAINT LOUIS MO
63128-2106
US

V. Phone/Fax

Practice location:
  • Phone: 314-525-1688
  • Fax: 314-525-1689
Mailing address:
  • Phone: 314-525-1688
  • Fax: 314-525-1689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number273-39
License Number StateMO

VIII. Authorized Official

Name: MS. CHERYL MATEJKA
Title or Position: CFO EAST COMMUNITIES & SFO
Credential:
Phone: 314-251-1958