Healthcare Provider Details

I. General information

NPI: 1295833580
Provider Name (Legal Business Name): MARY BIRD PERKINS CANCER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 ESSEN LANE
BATON ROUGE LA
70809
US

IV. Provider business mailing address

5215 ESSEN LN STE 200
BATON ROUGE LA
70809-3543
US

V. Phone/Fax

Practice location:
  • Phone: 225-215-1223
  • Fax: 225-766-0218
Mailing address:
  • Phone: 225-215-1281
  • Fax: 225-215-1380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JACOB KRAFT
Title or Position: DECISION SUPPORT MANAGER
Credential:
Phone: 225-215-1281