Active NPI
Laurance Monckton
- Surgery Physician
- Alton, IL
National Provider Identifier
1770590523
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 036074993
- Practice address
- 4 Memorial Dr
Ste 230
Alton, IL 62002-6751 - Phone
- (618) 462-3191
- Fax
- (618) 462-3379
- NPI assigned
- Aug 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 036074993 | IL | Primary |
Addresses
Primary practice location
4 Memorial Dr
Ste 230
Alton, IL 62002-6751
Mailing address
670 Mason Ridge Center Dr
Suite 300
Saint Louis, MO 63141-8573
Phone (618) 462-3191
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0360749932 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036074993 | IL | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fairview Heights Medical Group SC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Multi-Specialty Clinic/Center
- Saint Louis, MO
- NPI 1679503668
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1352764800000",
"number": "1770590523",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "670 MASON RIDGE CENTER DR",
"address_2": "SUITE 300",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631418573",
"telephone_number": "618-462-3191",
"fax_number": "618-462-3379"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4 MEMORIAL DR",
"address_2": "STE 230",
"city": "ALTON",
"state": "IL",
"postal_code": "620026751",
"telephone_number": "618-462-3191",
"fax_number": "618-462-3379"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONCKTON",
"first_name": "LAURANCE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-02",
"last_updated": "2012-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "IL",
"license": "036074993",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0360749932",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Alton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.