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General NPI Number Information
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NPI Number | 1912381005
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Entity Type | Organization
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Legal Business Name | SAINT LUKES RADIATION THERAPY-LIBERTY LLC
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Dates
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Enumeration Date | 07/17/2015
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Last Update Date | 08/30/2016
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Provider Practice Location Address
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Address Line | 2529 GLENN HENDREN DR SUITE G40
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City | LIBERTY
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State | MO
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Zip | 64068-9606
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Country | US
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Telephone | 816-251-5630
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Fax |
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Provider Business Mailing Address
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Address Line | 901 E 104TH ST SUITE 900
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City | KANSAS CITY
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State | MO
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Zip | 64013-3497
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Country | US
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Telephone | 816-932-2337
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | AMY M NACHTIGAL
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Credential |
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Telephone | 816-932-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0203X
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Taxonomy Name | Radiation Oncology Clinic/Center
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License Number | 4885
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License Number State | MO
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