Healthcare Provider Details

I. General information

NPI: 1609165711
Provider Name (Legal Business Name): NORTHSHORE ONCOLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 ROBERT BLVD STE 330
SLIDELL LA
70458-2014
US

IV. Provider business mailing address

4950 ESSEN LANE
BATON ROUGE LA
70809
US

V. Phone/Fax

Practice location:
  • Phone: 985-892-9090
  • Fax: 985-892-9957
Mailing address:
  • Phone: 225-215-1311
  • Fax: 225-766-0218

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: MRS. KRISTI C SIEMANN
Title or Position: MEDICAL STAFF SVCS COORDINATOR
Credential:
Phone: 225-215-1311