Provider Demographics
NPI:1861503120
Name:MEDICAL ONCOLOGY/HEMATOLOGY CONSULTANTS PC
Entity Type:Organization
Organization Name:MEDICAL ONCOLOGY/HEMATOLOGY CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MORICONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-842-6472
Mailing Address - Street 1:PO BOX 958858
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-8858
Mailing Address - Country:US
Mailing Address - Phone:314-878-0163
Mailing Address - Fax:314-842-5921
Practice Address - Street 1:12700 SOUTHFORK RD
Practice Address - Street 2:STE.125
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3201
Practice Address - Country:US
Practice Address - Phone:314-842-6472
Practice Address - Fax:314-842-5921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1B83207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201373925Medicaid
MO201373925Medicaid
MO4051230001Medicare NSC
MOA09834Medicare UPIN