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General NPI Number Information
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NPI Number | 1932156726
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Entity Type | Organization
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Legal Business Name | ST. LOUIS CANCER CARE, L.L.P.
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 11/14/2017
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Provider Practice Location Address
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Address Line | 10004 KENNERLY RD STE 137A
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2140
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Country | US
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Telephone | 314-842-7301
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Fax | 314-842-7308
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Provider Business Mailing Address
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Address Line | 10004 KENNERLY RD STE 137A
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2140
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Country | US
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Telephone | 314-842-7301
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Fax | 314-842-7308
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | CAROL J RILEY
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Credential | RN BSN
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Telephone | 314-965-6411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | R1C00
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 103666
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | R7758
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | R6F58
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License Number State | MO
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Taxonomy #5
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 2002002867
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License Number State | MO
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