=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861590234
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEMATOLOGY ONCOLOGY ASSOCIATES OF BATON ROUGE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 11/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4950 ESSEN LN
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70809-3432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-767-1311
-----------------------------------------------------
Fax | 225-215-1658
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4950 ESSEN LN
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70809-3482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-767-1311
-----------------------------------------------------
Fax | 225-767-1335
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | MR. PAUL NOWACKI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 225-215-1131
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085N0904X
-----------------------------------------------------
Taxonomy Name | Nuclear Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------