Basic Information
| Provider Information | |||||||||
| NPI: | 1275060485 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEMATOLOGY & ONCOLOGY ASSOCIATES AT ST. LUKE'S, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 SAINT LUKES CENTER DR STE 200 | ||||||||
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| City: | CHESTERFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630173518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6366857804 | ||||||||
| FaxNumber: | 3145762344 | ||||||||
| Practice Location | |||||||||
| Address1: | 232 S WOODS MILL RD STE 110E | ||||||||
| Address2: | |||||||||
| City: | CHESTERFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145424998 | ||||||||
| FaxNumber: | 3145424739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2017 | ||||||||
| LastUpdateDate: | 04/06/2021 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT AND CFO | ||||||||
| AuthorizedOfficialTelephone: | 3142056301 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ST. LUKES MEDICAL GROUP | ||||||||
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| NPICertificationDate: | 04/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 261QX0203X | Y | Ambulatory Health Care Facilities | Clinic/Center | Oncology, Radiation |
No ID Information.