Provider Demographics
NPI:1144281155
Name:MAHONEY, MEGAN M (MD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 E MAIN ST
Mailing Address - Street 2:BUSINESS OPTIONS MEDICAL BILLING
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3831
Mailing Address - Country:US
Mailing Address - Phone:970-765-0818
Mailing Address - Fax:970-497-8410
Practice Address - Street 1:308 MAIN STREET
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:CO
Practice Address - Zip Code:81425-0529
Practice Address - Country:US
Practice Address - Phone:970-323-6141
Practice Address - Fax:970-323-6117
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA32529207Q00000X
MN38854207Q00000X
CO51303207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN139H0MAOtherBCBSMN
CO371020YS6EOtherMEDICARE B PTAN FOR OLATHE COMMUNITY CLINIC DBA RVFHC
P00449455OtherRR MEDICARE PTAN
IA9174425Medicaid
WI34712700Medicaid
COCOA108893OtherMEDICARE PTAN BASIN CLINIC, NATURITA, CO
MN803521100Medicaid
HP69913OtherHEALTHPARTNERS
CO05622778Medicaid
112858OtherUCARE
COP01327013OtherRAILROAD WORKERS MEDICARE, BASIN CLINIC, NATURITA, CO
IAG44584Medicare UPIN
WI34712700Medicaid
CO05622778Medicaid
COP01327013OtherRAILROAD WORKERS MEDICARE, BASIN CLINIC, NATURITA, CO
WI34712700Medicaid