Provider Demographics
NPI:1457343634
Name:BALLAS CANCER CENTER, LLC
Entity Type:Organization
Organization Name:BALLAS CANCER CENTER, LLC
Other - Org Name:ST LOUIS CANCER & BREAST INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BORSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-989-1300
Mailing Address - Street 1:450 N NEW BALLAS RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6835
Mailing Address - Country:US
Mailing Address - Phone:314-989-1300
Mailing Address - Fax:
Practice Address - Street 1:450 N NEW BALLAS RD
Practice Address - Street 2:SUITE 270
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6835
Practice Address - Country:US
Practice Address - Phone:314-989-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5P45174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH33795Medicare UPIN