Provider Demographics
NPI:1487963179
Name:SSM CANCER CARE, INC
Entity type:Organization
Organization Name:SSM CANCER CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ELLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-496-2500
Mailing Address - Street 1:400 MEDICAL PLZ
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1490
Mailing Address - Country:US
Mailing Address - Phone:636-639-8600
Mailing Address - Fax:636-639-8676
Practice Address - Street 1:400 MEDICAL PLZ
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1490
Practice Address - Country:US
Practice Address - Phone:636-639-8600
Practice Address - Fax:636-639-8676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty