1992871719 NPI number — MISSOURI CANCER ASSOCIATES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992871719 NPI number — MISSOURI CANCER ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISSOURI CANCER ASSOCIATES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992871719
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1705 E BROADWAY STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65201-7167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-817-8527
Provider Business Mailing Address Fax Number:
573-449-4246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1705 E BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65201-7166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-817-8527
Provider Business Practice Location Address Fax Number:
573-449-4246
Provider Enumeration Date:
11/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PERKINS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
573-817-8527

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  2000151351 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 608518809 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com