Provider Demographics
NPI:1356316103
Name:MERCY ARCH HEMATOLOGY ONCOLOGY GROUP INC.
Entity Type:Organization
Organization Name:MERCY ARCH HEMATOLOGY ONCOLOGY GROUP INC.
Other - Org Name:MERCY CANCER CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BURTON
Authorized Official - Middle Name:M
Authorized Official - Last Name:NEEDLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-251-4986
Mailing Address - Street 1:607 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 3300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8219
Mailing Address - Country:US
Mailing Address - Phone:314-251-4986
Mailing Address - Fax:314-251-6375
Practice Address - Street 1:607 S NEW BALLAS RD
Practice Address - Street 2:SUITE 3300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8219
Practice Address - Country:US
Practice Address - Phone:314-251-4986
Practice Address - Fax:314-251-6375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500583703Medicaid
MO500586706Medicaid
MO500586706Medicaid
MO500583703Medicaid