Provider Demographics
NPI:1770684870
Name:NORTHEAST LOUISIANA RADIATION ONCOLOGY
Entity type:Organization
Organization Name:NORTHEAST LOUISIANA RADIATION ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-327-1930
Mailing Address - Street 1:PO BOX 3027
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71210-3027
Mailing Address - Country:US
Mailing Address - Phone:318-327-1917
Mailing Address - Fax:318-327-1938
Practice Address - Street 1:411 CALYPSO ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7506
Practice Address - Country:US
Practice Address - Phone:318-327-1900
Practice Address - Fax:318-327-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA=========OtherTAX ID#
LA5D605Medicare PIN