MEDICARE: SUGAR CREEK CANCER CENTER L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	R5635	MO
2	174400000X	Specialist	R5409	MO

General Provider Information

NPI Number	:	1124117841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUGAR CREEK CANCER CENTER L.L.C.

Provider Business Mailing Address
First Line	:	324 EMERSON RD
Second Line	:	SUITE A
City	:	HIGH RIDGE
State	:	MO
Zip	:	63049-2542
Country	:	US
Telephone Number	:	636-677-1800
Fax Number	:	636-677-8800

Provider Business Practice Location Address
First Line	:	324 EMERSON RD
Second Line	:	SUITE A
City	:	HIGH RIDGE
State	:	MO
Zip	:	63049-2542
Country	:	US
Telephone Number	:	636-677-1800
Fax Number	:	636-677-8800

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. MARY W CONTI
Credential	:	M D
Telephone Number	:	636-677-1800

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	04/20/2008

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