Healthcare Provider Details

I. General information

NPI: 1164785648
Provider Name (Legal Business Name): NORTH OAKS MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15790 PAUL VEGA MD DR RADIOLOGY DEPARTMENT
HAMMOND LA
70403-1434
US

IV. Provider business mailing address

PO BOX 1708
HAMMOND LA
70404-1708
US

V. Phone/Fax

Practice location:
  • Phone: 985-230-1101
  • Fax: 985-230-1097
Mailing address:
  • Phone: 985-230-1101
  • Fax: 985-230-1097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number703
License Number StateLA

VIII. Authorized Official

Name: MR. MARK T ANDERSON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 985-230-6602