Provider Demographics
NPI:1275081465
Name:EAST JEFFERSON GENERAL HOSPITAL
Entity Type:Organization
Organization Name:EAST JEFFERSON GENERAL HOSPITAL
Other - Org Name:EJGH WELLNESS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXEC VP / CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:NAREMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-503-6410
Mailing Address - Street 1:4200 HOUMA BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2970
Mailing Address - Country:US
Mailing Address - Phone:504-503-4000
Mailing Address - Fax:
Practice Address - Street 1:3726 HOUMA BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4116
Practice Address - Country:US
Practice Address - Phone:504-503-6868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST JEFFERSON GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA122282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1474886Medicaid
LA1705055Medicaid
LA1735183Medicaid
LA1705055Medicaid
LA1735183Medicaid