Healthcare Provider Details

I. General information

NPI: 1154637395
Provider Name (Legal Business Name): MONAGHAN HEALTH GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON AVE SUITE 161
SAINT LOUIS MO
63101-1202
US

IV. Provider business mailing address

800 WASHINGTON AVE SUITE 161
SAINT LOUIS MO
63101-1202
US

V. Phone/Fax

Practice location:
  • Phone: 314-556-4489
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number04-30958
License Number StateMO

VIII. Authorized Official

Name: GREG MONAGHAN
Title or Position: CEO
Credential:
Phone: 314-556-4489