1508820317 NPI number — HEMATOLOGY & ONCOLOGY SPECIALISTS LLC

Table of content: TRACI BLALOCK PHILLIPS B.S. M.S. DMIN. (NPI 1467906784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508820317 NPI number — HEMATOLOGY & ONCOLOGY SPECIALISTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEMATOLOGY & ONCOLOGY SPECIALISTS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508820317
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 54932
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-883-2960
Provider Business Mailing Address Fax Number:
504-883-2967

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4228 HOUMA BLVD
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70006-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-883-2960
Provider Business Practice Location Address Fax Number:
504-883-2967
Provider Enumeration Date:
04/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COSGRIFF
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
M
Authorized Official Title or Position:
EXECUTIVE COMMITTEE
Authorized Official Telephone Number:
504-883-2960

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1947041 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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