Provider Demographics
NPI:1891563334
Name:LAUREL CANCER CARE, LLC
Entity Type:Organization
Organization Name:LAUREL CANCER CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE LEADER
Authorized Official - Prefix:
Authorized Official - First Name:LADONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-425-9999
Mailing Address - Street 1:127 S 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-4111
Mailing Address - Country:US
Mailing Address - Phone:601-425-2999
Mailing Address - Fax:601-425-3286
Practice Address - Street 1:127 S 13TH AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4111
Practice Address - Country:US
Practice Address - Phone:601-425-2999
Practice Address - Fax:601-425-3286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty