Provider Demographics
NPI:1679631402
Name:WEST JEFFERSON HOLDINGS, LLC
Entity Type:Organization
Organization Name:WEST JEFFERSON HOLDINGS, LLC
Other - Org Name:WEST JEFFERSON MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PATIENT BUSINESS SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-349-1383
Mailing Address - Street 1:1101 MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3147
Mailing Address - Country:US
Mailing Address - Phone:504-349-1383
Mailing Address - Fax:504-349-1334
Practice Address - Street 1:1101 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3147
Practice Address - Country:US
Practice Address - Phone:504-349-1383
Practice Address - Fax:504-349-1334
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST JEFFERSON HOLDINGS, LLS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-05
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA236273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19T039Medicare Oscar/Certification