Provider Demographics
NPI:1356300735
Name:ST JOSEPH ONCOLOGY INC
Entity Type:Organization
Organization Name:ST JOSEPH ONCOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJAGOPAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:RANGINENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-271-1301
Mailing Address - Street 1:902 NO RIVERSIDE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507
Mailing Address - Country:US
Mailing Address - Phone:816-271-1301
Mailing Address - Fax:816-271-1302
Practice Address - Street 1:902 NO RIVERSIDE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ST JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507
Practice Address - Country:US
Practice Address - Phone:816-271-1301
Practice Address - Fax:816-271-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS073224OtherBLUE CROSS BLUE SHIELD
KS110494OtherBLUE CROSS BLUE SHIELD
MO13453018OtherBLUE CROSS BLUE SHIELD
KS1104949STMedicare ID - Type Unspecified
MO13453018OtherBLUE CROSS BLUE SHIELD