MEDICARE: MERCY ARCH HEMATOLOGY ONCOLOGY GROUP INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician		MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356316103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY ARCH HEMATOLOGY ONCOLOGY GROUP INC.

Provider Business Mailing Address
First Line	:	607 S NEW BALLAS RD
Second Line	:	SUITE 3300
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8219
Country	:	US
Telephone Number	:	314-251-4986
Fax Number	:	314-251-6375

Provider Business Practice Location Address
First Line	:	607 S NEW BALLAS RD
Second Line	:	SUITE 3300
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8219
Country	:	US
Telephone Number	:	314-251-4986
Fax Number	:	314-251-6375

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BURTON M NEEDLES
Credential	:	M.D.
Telephone Number	:	314-251-4986

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	02/04/2010

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