Organization
MISSOURI CANCER CARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA J VINCENT (ADMINISTRATOR)
(636) 639-8650
Entity
Organization
Contact information
Practice address
400 MEDICAL PLAZA, SUITE 100, LAKE ST. LOUIS, MO 63367
(636) 639-8620
(636) 639-8665
Mailing address
1078 WENTZVILLE PARKWAY, WENTZVILLE, MO 63385
(636) 639-8644
(636) 639-8665
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
2085R0001X
Radiation Oncology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
507598704
—
MO
Enumeration date
12/08/2006
Last updated
12/10/2008
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