Provider Demographics
NPI:1588609929
Name:HEMATOLOGY ONCOLOGY ASSOCIATES LLC
Entity type:Organization
Organization Name:HEMATOLOGY ONCOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-332-0226
Mailing Address - Street 1:1723 BROADWAY ST
Mailing Address - Street 2:SUITE 315
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-4505
Mailing Address - Country:US
Mailing Address - Phone:573-332-0226
Mailing Address - Fax:573-332-0344
Practice Address - Street 1:1723 BROADWAY ST
Practice Address - Street 2:SUITE 315
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4505
Practice Address - Country:US
Practice Address - Phone:573-332-0226
Practice Address - Fax:573-332-0344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004012760207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F18236Medicare UPIN