Provider Demographics
NPI:1235595778
Name:J & A LEGROS ENTERPRISES LLC
Entity Type:Organization
Organization Name:J & A LEGROS ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-684-0911
Mailing Address - Street 1:731 S MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHURCH POINT
Mailing Address - State:LA
Mailing Address - Zip Code:70525-4109
Mailing Address - Country:US
Mailing Address - Phone:337-684-0911
Mailing Address - Fax:337-684-0912
Practice Address - Street 1:731 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:CHURCH POINT
Practice Address - State:LA
Practice Address - Zip Code:70525-4109
Practice Address - Country:US
Practice Address - Phone:337-684-0911
Practice Address - Fax:337-684-0912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03265363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty