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NPI Code Detail

MEDICARE: MARY BIRD PERKINS CANCER CENTER

MEDICARE: MARY BIRD PERKINS CANCER CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CDS.067595-PHYOTHERLAPHARMACY CDS LICENSE
2PST.025224OTHERLAPIC
3PHY.008821-IROTHERLAPHARMACY LICENSE
4PIC.025224OTHERLAPIC

General Provider Information

NPI Number : 1407492184
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARY BIRD PERKINS CANCER CENTER
Provider Business Mailing Address
First Line : 4950 ESSEN LN
Second Line :
City : BATON ROUGE
State : LA
Zip : 70809-3738
Country : US
Telephone Number : 225-215-1281
Fax Number : 225-215-1380
Provider Business Practice Location Address
First Line : 10600 INDUSTRIAL DR STE B
Second Line :
City : MINDEN
State : LA
Zip : 71055-5105
Country : US
Telephone Number : 318-716-7541
Fax Number : 318-202-8707
Authorized Official
Title or Position : CFO
Name : SANDRA COURVILLE LEBLANC
Credential :
Telephone Number : 225-215-1321
Provider Enumeration Date : 11/18/2019
Last Update Date : 12/10/2024

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Directions to “MARY BIRD PERKINS CANCER CENTER ” Practice Location

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