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General NPI Number Information
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NPI Number | 1700889458
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Entity Type | Organization
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Legal Business Name | HEMATOLOGY ONCOLOGY LIFE CENTER, LLC
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Dates
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Enumeration Date | 05/25/2005
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Last Update Date | 06/25/2020
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Provider Practice Location Address
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Address Line | 605B MEDICAL CENTER DR
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City | ALEXANDRIA
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State | LA
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Zip | 71301-8127
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Country | US
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Telephone | 318-442-2232
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Fax | 318-442-2192
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Provider Business Mailing Address
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Address Line | 605 MEDICAL CENTER DR STE B
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City | ALEXANDRIA
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State | LA
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Zip | 71301-8145
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Country | US
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Telephone | 318-442-2232
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Fax | 318-442-2192
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Authorized Official
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Title or Position | LABORATORY DIRECTOR
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Name | DR. HOWARD G WOLD
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Credential | M.D.
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Telephone | 318-442-2232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 19D0464720
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License Number State | LA
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