Organization
ST. JUDE CHILDREN'S RESEARCH HOSPITAL
Active
Organization
ST. JUDE CHILDREN'S RESEARCH HOSPITAL
Active
Other names
St. Jude Affiliate/Baton Rouge
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL C CANARIOS (VP/CFO)
(901) 495-3006
Entity
Organization
Contact information
Practice address
7777 HENNESSY BLVD, STE. 312, BATON ROUGE, LA 70808-4300
(225) 763-6337
(225) 761-4072
Mailing address
7777 HENNESSY BLVD, STE. 312, BATON ROUGE, LA 70808-4300
(225) 763-6337
(225) 761-4072
Taxonomy
Speciality
Code
Description
License number
State
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01554572
—
MS
05
—
1446131
—
LA
01
—
2678828
AETNA
LA
Enumeration date
08/01/2006
Last updated
08/22/2020
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