Provider Demographics
NPI:1639135585
Name:MISSION CANCER AND BLOOD, PLLC
Entity Type:Organization
Organization Name:MISSION CANCER AND BLOOD, PLLC
Other - Org Name:MISSION CANCER AND BLOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:BUROKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:515-282-2921
Mailing Address - Street 1:1221 PLEASANT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1424
Mailing Address - Country:US
Mailing Address - Phone:515-282-2921
Mailing Address - Fax:515-282-1035
Practice Address - Street 1:1221 PLEASANT
Practice Address - Street 2:SUITE 100
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309
Practice Address - Country:US
Practice Address - Phone:515-282-2921
Practice Address - Fax:515-282-1035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2022-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA58988Medicare ID - Type Unspecified