Provider Demographics
NPI:1437489168
Name:COUNTY ONCOLOGIST, INC.
Entity Type:Organization
Organization Name:COUNTY ONCOLOGIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:OSWALD
Authorized Official - Last Name:CARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-355-8200
Mailing Address - Street 1:11125 DUNN ROAD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136
Mailing Address - Country:US
Mailing Address - Phone:314-355-8200
Mailing Address - Fax:314-355-4582
Practice Address - Street 1:11125 DUNN RD
Practice Address - Street 2:SUITE 108
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6132
Practice Address - Country:US
Practice Address - Phone:314-355-8200
Practice Address - Fax:314-355-4582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO34924207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201892601Medicaid
MOA10943Medicare UPIN