Provider Demographics
NPI:1811916109
Name:PONTCHARTRAIN CANCER CENTER INC
Entity type:Organization
Organization Name:PONTCHARTRAIN CANCER CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:OUBRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-419-0025
Mailing Address - Street 1:15799 PROFESSIONAL PLZ
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1452
Mailing Address - Country:US
Mailing Address - Phone:985-419-5220
Mailing Address - Fax:985-419-0035
Practice Address - Street 1:15799 PROFESSIONAL PLZ
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1452
Practice Address - Country:US
Practice Address - Phone:985-419-0025
Practice Address - Fax:985-419-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022330207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1883883Medicaid
LA5CS13Medicare PIN
LA1883883Medicaid