Healthcare Provider Details

I. General information

NPI: 1013126408
Provider Name (Legal Business Name): WOMENS & CHILDRENS PEDIATRIC HEMATOLOGY - ONCOLOGY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 AMBASSADOR CAFFERY PKWY SUITE 414
LAFAYETTE LA
70508-6949
US

IV. Provider business mailing address

4630 AMBASSADOR CAFFERY PKWY SUITE 414
LAFAYETTE LA
70508-6949
US

V. Phone/Fax

Practice location:
  • Phone: 337-521-9239
  • Fax: 337-521-9268
Mailing address:
  • Phone: 337-521-9239
  • Fax: 337-521-9268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS ROBERT J. LAGESSE
Title or Position: VICE PRESIDENT
Credential:
Phone: 615-373-7600