Provider Demographics
NPI:1568886273
Name:COLUMBIA COMPREHENSIVE CANCER CARE CLINIC
Entity Type:Organization
Organization Name:COLUMBIA COMPREHENSIVE CANCER CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOJASTEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-442-6800
Mailing Address - Street 1:500 N KEENE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8104
Mailing Address - Country:US
Mailing Address - Phone:573-442-6800
Mailing Address - Fax:573-449-4943
Practice Address - Street 1:500 N KEENE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8104
Practice Address - Country:US
Practice Address - Phone:573-442-6800
Practice Address - Fax:573-449-4943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9764207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty