Provider Demographics
NPI:1669821864
Name:NORTHSHORE ONCOLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:NORTHSHORE ONCOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:E
Authorized Official - Last Name:SAUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-892-9090
Mailing Address - Street 1:4950 ESSEN LN
Mailing Address - Street 2:ATTN KRISTI SIEMANN
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3738
Mailing Address - Country:US
Mailing Address - Phone:225-215-1311
Mailing Address - Fax:
Practice Address - Street 1:1203 S TYLER ST STE 230
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2353
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:2016-06-08
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty