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General NPI Number Information
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NPI Number | 1225258809
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Entity Type | Organization
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Legal Business Name | RADIATION ONCOLOGY ST MARY PLACE LLC
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | ONE SAINT MARY PLACE CANCER TREATMENT CENTER
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City | SHREVEPORT
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State | LA
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Zip | 71101-4343
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Country | US
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Telephone | 318-681-4126
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9600 DEPT 09 042
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City | TEXARKANA
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State | TX
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Zip | 75505
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MD OWNER
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Name | LANE ROSEN
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Credential | MD
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Telephone | 318-222-1149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 022404
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License Number State | LA
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