Provider Demographics
NPI:1164432290
Name:WEST JEFFERSON MEDICAL CENTER
Entity Type:Organization
Organization Name:WEST JEFFERSON MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:THELMA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SONZA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:504-347-5511
Mailing Address - Street 1:1721 LAKE SUPERIOR DR
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-5138
Mailing Address - Country:US
Mailing Address - Phone:504-367-4040
Mailing Address - Fax:504-367-4040
Practice Address - Street 1:1721 LAKE SUPERIOR DR
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-5138
Practice Address - Country:US
Practice Address - Phone:504-367-4040
Practice Address - Fax:504-367-4040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1165018Medicaid
LA1165018Medicaid