Provider Demographics
NPI:1720278138
Name:OCCUPATIONAL MEDICINE CENTER OF WEST JEFFERSON
Entity Type:Organization
Organization Name:OCCUPATIONAL MEDICINE CENTER OF WEST JEFFERSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TSAO
Authorized Official - Middle Name:TE
Authorized Official - Last Name:WEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-347-8471
Mailing Address - Street 1:3607 OLD CONEJO RD
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-2123
Mailing Address - Country:US
Mailing Address - Phone:805-375-0800
Mailing Address - Fax:
Practice Address - Street 1:4475 WESTBANK EXPY
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3102
Practice Address - Country:US
Practice Address - Phone:504-347-8471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LABW4947454332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site