Provider Demographics
NPI:1861590234
Name:HEMATOLOGY ONCOLOGY ASSOCIATES OF BATON ROUGE
Entity type:Organization
Organization Name:HEMATOLOGY ONCOLOGY ASSOCIATES OF BATON ROUGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOWACKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-215-1131
Mailing Address - Street 1:4950 ESSEN LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3482
Mailing Address - Country:US
Mailing Address - Phone:225-767-1311
Mailing Address - Fax:225-767-1335
Practice Address - Street 1:4950 ESSEN LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3432
Practice Address - Country:US
Practice Address - Phone:225-767-1311
Practice Address - Fax:225-215-1658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2085N0904X, 2085R0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1440850Medicaid
LA1861590234OtherNPI
MS09014497OtherMISSISSIPPI MEDICAID
LA72146800OtherBLUE CROSS BLUE SHIELD
LACH2372OtherMEDICARE RAILROAD
LACH2372OtherMEDICARE RAILROAD
LA1440850Medicaid