Provider Demographics
NPI:1396776837
Name:WEST JEFFERSON MRI, LLC
Entity type:Organization
Organization Name:WEST JEFFERSON MRI, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-291-9161
Mailing Address - Street 1:4525 WESTBANK EXPY
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3120
Mailing Address - Country:US
Mailing Address - Phone:504-349-6570
Mailing Address - Fax:504-349-6195
Practice Address - Street 1:4525 WESTBANK EXPY
Practice Address - Street 2:SUITE B
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3120
Practice Address - Country:US
Practice Address - Phone:504-349-6570
Practice Address - Fax:504-349-6195
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST JEFFERSON MRI LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-05
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes293D00000XLaboratoriesPhysiological Laboratory
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1442607Medicaid
LA5C959Medicare PIN