Healthcare Provider Details

I. General information

NPI: 1326136102
Provider Name (Legal Business Name): ONCOLOGY/HEMATOLOGY CENTER OF THE SOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8166 MAIN ST STE 201
HOUMA LA
70360-3404
US

IV. Provider business mailing address

8166 MAIN ST STE 201
HOUMA LA
70360-3404
US

V. Phone/Fax

Practice location:
  • Phone: 985-857-8093
  • Fax: 985-857-8902
Mailing address:
  • Phone: 985-857-8093
  • Fax: 985-857-8902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

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