Provider Demographics
NPI:1942876487
Name:MIDAMERICA CANCER CARE, LLC
Entity Type:Organization
Organization Name:MIDAMERICA CANCER CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAKLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:EASTLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-605-9756
Mailing Address - Street 1:1010 CARONDELET DR STE 121
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4859
Mailing Address - Country:US
Mailing Address - Phone:816-912-2100
Mailing Address - Fax:636-438-0430
Practice Address - Street 1:1010 CARONDELET DR STE 121
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4859
Practice Address - Country:US
Practice Address - Phone:816-912-2100
Practice Address - Fax:636-438-0430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty