Healthcare Provider Details

I. General information

NPI: 1740147131
Provider Name (Legal Business Name): PROSTATE CANCER INSTITUTE OF LOUISIANA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71207 HIGHWAY 21
COVINGTON LA
70433-7121
US

IV. Provider business mailing address

PO BOX 15088
PHOENIX AZ
85060-5088
US

V. Phone/Fax

Practice location:
  • Phone: 985-271-8990
  • Fax: 985-271-8991
Mailing address:
  • Phone: 985-271-8990
  • Fax: 985-271-8991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: AJAY BHATNAGAR
Title or Position: OWNER AND PHYSICIAN
Credential: MD
Phone: 985-271-8990