Provider Demographics
NPI:1124117841
Name:SUGAR CREEK CANCER CENTER L.L.C.
Entity type:Organization
Organization Name:SUGAR CREEK CANCER CENTER L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:CONTI
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:636-677-1800
Mailing Address - Street 1:324 EMERSON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HIGH RIDGE
Mailing Address - State:MO
Mailing Address - Zip Code:63049-2542
Mailing Address - Country:US
Mailing Address - Phone:636-677-1800
Mailing Address - Fax:636-677-8800
Practice Address - Street 1:324 EMERSON RD
Practice Address - Street 2:SUITE A
Practice Address - City:HIGH RIDGE
Practice Address - State:MO
Practice Address - Zip Code:63049-2542
Practice Address - Country:US
Practice Address - Phone:636-677-1800
Practice Address - Fax:636-677-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5635174400000X
MOR5409174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========OtherHEALTHCARE USA