MEDICARE: WESTBANK FAMILY MEDICINE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568504066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTBANK FAMILY MEDICINE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1550
Second Line	:
City	:	MORGAN CITY
State	:	LA
Zip	:	70381-1550
Country	:	US
Telephone Number	:	985-380-2806
Fax Number	:	985-380-2608

Provider Business Practice Location Address
First Line	:	1151 MARGUERITE ST
Second Line	:	SUITE 200 B
City	:	MORGAN CITY
State	:	LA
Zip	:	70380-1850
Country	:	US
Telephone Number	:	985-380-2806
Fax Number	:	985-380-2608

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JOHN M DESROSIERS
Credential	:
Telephone Number	:	985-380-2806

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	12/28/2008

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