MEDICARE: HEMATOLOGY ONCOLOGY ASSOCIATES LLC

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	207RH0003X	Hematology & Oncology Physician	2004012760	MO

General Provider Information

NPI Number	:	1588609929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEMATOLOGY ONCOLOGY ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	1723 BROADWAY ST
Second Line	:	SUITE 315
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-4505
Country	:	US
Telephone Number	:	573-332-0226
Fax Number	:	573-332-0344

Provider Business Practice Location Address
First Line	:	1723 BROADWAY ST
Second Line	:	SUITE 315
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-4505
Country	:	US
Telephone Number	:	573-332-0226
Fax Number	:	573-332-0344

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MRS. PATSY J GREEN
Credential	:
Telephone Number	:	573-332-0226

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	08/22/2020

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