Provider Demographics
NPI:1326136102
Name:ONCOLOGY/HEMATOLOGY CENTER OF THE SOUTH
Entity Type:Organization
Organization Name:ONCOLOGY/HEMATOLOGY CENTER OF THE SOUTH
Other - Org Name:CANCER CARE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:NOWACKI
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:225-215-1223
Mailing Address - Street 1:8166 MAIN ST
Mailing Address - Street 2:STE 201
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-3404
Mailing Address - Country:US
Mailing Address - Phone:985-857-8093
Mailing Address - Fax:985-857-8902
Practice Address - Street 1:8166 MAIN ST
Practice Address - Street 2:STE 201
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-3404
Practice Address - Country:US
Practice Address - Phone:985-857-8093
Practice Address - Fax:985-857-8902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1947466Medicaid
LA1947466Medicaid