Provider Demographics
NPI:1538112248
Name:EAST JEFFERSON AFTER HOURS, METAIRIE, LLC
Entity Type:Organization
Organization Name:EAST JEFFERSON AFTER HOURS, METAIRIE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CVITANOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-838-3524
Mailing Address - Street 1:2215 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-6322
Mailing Address - Country:US
Mailing Address - Phone:504-838-3524
Mailing Address - Fax:504-831-3778
Practice Address - Street 1:2215 VETERANS MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-6322
Practice Address - Country:US
Practice Address - Phone:504-838-3524
Practice Address - Fax:504-831-3778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CT91Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER