Provider Demographics
NPI:1124000773
Name:JEFFERSON COMMUNITY HEALTH CARE CENTERS INC
Entity Type:Organization
Organization Name:JEFFERSON COMMUNITY HEALTH CARE CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE/CREDENTIALING
Authorized Official - Prefix:MISS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LOVELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-436-2223
Mailing Address - Street 1:4028 HIGHWAY 90 W
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:LA
Mailing Address - Zip Code:70094-2622
Mailing Address - Country:US
Mailing Address - Phone:504-436-2223
Mailing Address - Fax:504-436-2224
Practice Address - Street 1:4028 HIGHWAY 90 W
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:LA
Practice Address - Zip Code:70094-2622
Practice Address - Country:US
Practice Address - Phone:504-436-2223
Practice Address - Fax:504-436-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1447196Medicaid
LA5CM83Medicare ID - Type Unspecified