Organization
MONUMENT DIAGNOSTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY DELONG (NPI REPRESENTATIVE)
(210) 598-2800
Entity
Organization
Contact information
Practice address
4579 LACLEDE AVE, PMB #282, SAINT LOUIS, MO 63108-2103
(314) 627-0214
Mailing address
4579 LACLEDE AVE, PMB #282, SAINT LOUIS, MO 63108-2103
Taxonomy
Speciality
Code
Description
License number
State
2084N0600X
Clinical Neurophysiology Physician
Primary
—
—
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
—
—
Other
Enumeration date
06/26/2017
Last updated
11/17/2017
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