Provider Demographics
NPI:1164785648
Name:NORTH OAKS MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:NORTH OAKS MEDICAL CENTER, LLC
Other - Org Name:HOSPITAL BASED PHYSICIANS - RADIOLOGISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-230-6602
Mailing Address - Street 1:PO BOX 1708
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-1708
Mailing Address - Country:US
Mailing Address - Phone:985-230-1101
Mailing Address - Fax:985-230-1097
Practice Address - Street 1:15790 PAUL VEGA MD DR
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1434
Practice Address - Country:US
Practice Address - Phone:985-230-1101
Practice Address - Fax:985-230-1097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085R0202X
LA703282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DY44Medicaid
LAPENDINGMedicare PIN