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NPI Code Detail

MEDICARE: HEMATOLOGY ONCOLOGY LIFE CENTER, LLC

MEDICARE: HEMATOLOGY ONCOLOGY LIFE CENTER, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory19D0464720LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
119D0464720OTHERLACLIA ID #

General Provider Information

NPI Number : 1700889458
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEMATOLOGY ONCOLOGY LIFE CENTER, LLC
Provider Business Mailing Address
First Line : 605 MEDICAL CENTER DR STE B
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71301-8145
Country : US
Telephone Number : 318-442-2232
Fax Number : 318-442-2192
Provider Business Practice Location Address
First Line : 605B MEDICAL CENTER DR
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71301-8127
Country : US
Telephone Number : 318-442-2232
Fax Number : 318-442-2192
Authorized Official
Title or Position : LABORATORY DIRECTOR
Name : DR. HOWARD G WOLD
Credential : M.D.
Telephone Number : 318-442-2232
Provider Enumeration Date : 05/25/2005
Last Update Date : 06/25/2020

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