Provider Demographics
NPI:1912381005
Name:SAINT LUKES RADIATION THERAPY-LIBERTY LLC
Entity Type:Organization
Organization Name:SAINT LUKES RADIATION THERAPY-LIBERTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:NACHTIGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-932-2000
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64013-3497
Mailing Address - Country:US
Mailing Address - Phone:816-932-2337
Mailing Address - Fax:
Practice Address - Street 1:2529 GLENN HENDREN DR
Practice Address - Street 2:SUITE G40
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-9606
Practice Address - Country:US
Practice Address - Phone:816-251-5630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO4885261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01685370OtherRAILROAD MEDICARE
MO1912381005Medicaid
MO1912381005Medicaid