Healthcare Provider Details

I. General information

NPI: 1225274483
Provider Name (Legal Business Name): MARY BIRD PERKINS CANCER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 ESSEN LN
BATON ROUGE LA
70809-3738
US

IV. Provider business mailing address

4950 ESSEN LN
BATON ROUGE LA
70809-3738
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-0847
  • Fax: 225-766-0218
Mailing address:
  • Phone: 225-767-0847
  • Fax: 225-766-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL R. NOWACKI
Title or Position: CFO
Credential:
Phone: 225-215-1223