Provider Demographics
NPI:1134318868
Name:BAYOU ONCOLOGY SPECIALISTS, LLC
Entity Type:Organization
Organization Name:BAYOU ONCOLOGY SPECIALISTS, LLC
Other - Org Name:BAYOU ONCOLOGY SPECIALISTS,LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOUISA
Authorized Official - Middle Name:G
Authorized Official - Last Name:GAUDET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-493-4334
Mailing Address - Street 1:608 N ACADIA RD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4847
Mailing Address - Country:US
Mailing Address - Phone:985-493-4334
Mailing Address - Fax:985-449-2515
Practice Address - Street 1:608 N ACADIA RD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4847
Practice Address - Country:US
Practice Address - Phone:985-493-4334
Practice Address - Fax:985-449-2515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10104R261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5D312Medicare PIN