Provider Demographics
NPI:1770586240
Name:WESTBANK UROLOGY
Entity type:Organization
Organization Name:WESTBANK UROLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:BAILES
Authorized Official - Last Name:REYNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-393-5858
Mailing Address - Street 1:2600 BELLE CHASSE HWY
Mailing Address - Street 2:
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7156
Mailing Address - Country:US
Mailing Address - Phone:504-394-7000
Mailing Address - Fax:504-394-6757
Practice Address - Street 1:2600 BELLE CHASSE HWY
Practice Address - Street 2:
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-7156
Practice Address - Country:US
Practice Address - Phone:504-394-7000
Practice Address - Fax:504-394-6757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA692839OtherAETNA
LA1795135Medicaid
LACP2626OtherMEDICARE RAILROAD
LACP2626OtherMEDICARE RAILROAD