Healthcare Provider Details

I. General information

NPI: 1700889458
Provider Name (Legal Business Name): HEMATOLOGY ONCOLOGY LIFE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2005
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605B MEDICAL CENTER DR
ALEXANDRIA LA
71301-8127
US

IV. Provider business mailing address

605 MEDICAL CENTER DR STE B
ALEXANDRIA LA
71301-8145
US

V. Phone/Fax

Practice location:
  • Phone: 318-442-2232
  • Fax: 318-442-2192
Mailing address:
  • Phone: 318-442-2232
  • Fax: 318-442-2192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number19D0464720
License Number StateLA

VIII. Authorized Official

Name: DR. HOWARD G WOLD
Title or Position: LABORATORY DIRECTOR
Credential: M.D.
Phone: 318-442-2232