Provider Demographics
NPI:1164687422
Name:WESTSIDE FAMILY HEALTHCARE LLC
Entity Type:Organization
Organization Name:WESTSIDE FAMILY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRIETTE
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:FITCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-687-8838
Mailing Address - Street 1:58155 CHINN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-3607
Mailing Address - Country:US
Mailing Address - Phone:225-687-8838
Mailing Address - Fax:225-687-8836
Practice Address - Street 1:58155 CHINN ST
Practice Address - Street 2:SUITE B
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-3607
Practice Address - Country:US
Practice Address - Phone:225-687-8838
Practice Address - Fax:225-687-8836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA23650207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LADE7061OtherRAILROAD MEDICARE
LA1446548Medicaid
LA5CF44Medicare PIN