Provider Demographics
NPI:1568504066
Name:WESTBANK FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:WESTBANK FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DESROSIERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-380-2806
Mailing Address - Street 1:PO BOX 1550
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70381-1550
Mailing Address - Country:US
Mailing Address - Phone:985-380-2806
Mailing Address - Fax:985-380-2608
Practice Address - Street 1:1151 MARGUERITE ST
Practice Address - Street 2:SUITE 200 B
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1850
Practice Address - Country:US
Practice Address - Phone:985-380-2806
Practice Address - Fax:985-380-2608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1568911Medicaid
LA1568911Medicaid
LA5H218CB36Medicare ID - Type Unspecified