MEDICARE: ST. ELIZABETH-MARY BIRD PERKINS CANCER CENTER, L.L.C.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2085N0904X	Nuclear Radiology Physician
2	2085R0203X	Therapeutic Radiology Physician
3	2085R0202X	Diagnostic Radiology Physician
4	2085R0001X	Radiation Oncology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619155124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. ELIZABETH-MARY BIRD PERKINS CANCER CENTER, L.L.C.

Provider Business Mailing Address
First Line	:	5215 ESSEN LN STE 200
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-3543
Country	:	US
Telephone Number	:	225-215-1281
Fax Number	:	225-215-1380

Provider Business Practice Location Address
First Line	:	1104 W HIGHWAY 30
Second Line	:
City	:	GONZALES
State	:	LA
Zip	:	70737-5003
Country	:	US
Telephone Number	:	225-215-1223
Fax Number	:	225-766-0218

Authorized Official
Title or Position	:	DECISION SUPPORT MANAGER
Name	:	JACOB KRAFT
Credential	:
Telephone Number	:	225-215-1281

Provider Enumeration Date	:	02/06/2008
Last Update Date	:	12/18/2025

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