=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154637395
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONAGHAN HEALTH GROUP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2010
-----------------------------------------------------
Last Update Date | 08/25/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 WASHINGTON AVE SUITE 161
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63101-1202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-556-4489
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 WASHINGTON AVE SUITE 161
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63101-1202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | GREG MONAGHAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-556-4489
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 04-30958
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------