Provider Demographics
NPI:1215947338
Name:MISSOURI CANCER ASSOCIATES LLC
Entity type:Organization
Organization Name:MISSOURI CANCER ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:ILIFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-874-7800
Mailing Address - Street 1:1705 E BROADWAY STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-7167
Mailing Address - Country:US
Mailing Address - Phone:573-874-7800
Mailing Address - Fax:573-443-3627
Practice Address - Street 1:1705 E BROADWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5852
Practice Address - Country:US
Practice Address - Phone:573-874-7800
Practice Address - Fax:573-443-3627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO501811509Medicaid
MO509696605Medicaid
MO509696605Medicaid
MOMA1231Medicare PIN
MO1144430001Medicare NSC
MO501811509Medicaid
KSH380000Medicare PIN