Provider Demographics
NPI:1609165711
Name:NORTHSHORE ONCOLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:NORTHSHORE ONCOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL STAFF SVCS COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:C
Authorized Official - Last Name:SIEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-215-1311
Mailing Address - Street 1:4950 ESSEN LANE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809
Mailing Address - Country:US
Mailing Address - Phone:225-215-1311
Mailing Address - Fax:225-766-0218
Practice Address - Street 1:1120 ROBERT BLVD
Practice Address - Street 2:STE 330
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2014
Practice Address - Country:US
Practice Address - Phone:985-892-9090
Practice Address - Fax:985-892-9957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2142089Medicaid
MS00938275OtherMISSISSIPPI MEDICAID
LA5DT31Medicare UPIN