Provider Demographics
NPI:1932156726
Name:ST. LOUIS CANCER CARE, L.L.P.
Entity Type:Organization
Organization Name:ST. LOUIS CANCER CARE, L.L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:314-965-6411
Mailing Address - Street 1:10004 KENNERLY RD STE 137A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2140
Mailing Address - Country:US
Mailing Address - Phone:314-842-7301
Mailing Address - Fax:314-842-7308
Practice Address - Street 1:10004 KENNERLY RD STE 137A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2140
Practice Address - Country:US
Practice Address - Phone:314-842-7301
Practice Address - Fax:314-842-7308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1C00207RH0003X
MO103666207RH0003X
MOR7758207RH0003X
MOR6F58207RH0003X
MO2002002867207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000011025Medicare ID - Type Unspecified