Healthcare Provider Details

I. General information

NPI: 1407169915
Provider Name (Legal Business Name): MERCY CLINIC ONCOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 E 5TH ST SUITE 304
WASHINGTON MO
63090-3135
US

IV. Provider business mailing address

851 E 5TH ST SUITE 304
WASHINGTON MO
63090-3135
US

V. Phone/Fax

Practice location:
  • Phone: 636-432-0055
  • Fax: 636-390-7332
Mailing address:
  • Phone: 636-432-0055
  • Fax: 636-390-7332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

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