Provider Demographics
NPI:1659698231
Name:HEARTLAND CLINIC CANCER CENTER ST JOSEPH ONCOLOGY
Entity Type:Organization
Organization Name:HEARTLAND CLINIC CANCER CENTER ST JOSEPH ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CUSICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-271-1301
Mailing Address - Street 1:902 N RIVERSIDE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-2559
Mailing Address - Country:US
Mailing Address - Phone:816-271-1301
Mailing Address - Fax:816-271-1302
Practice Address - Street 1:902 N RIVERSIDE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-2559
Practice Address - Country:US
Practice Address - Phone:816-271-1301
Practice Address - Fax:816-271-1302
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3D52207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty