Healthcare Provider Details

I. General information

NPI: 1932152626
Provider Name (Legal Business Name): EAST JEFFERSON AFTER HOURS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 W ESPLANADE AVE
KENNER LA
70065-2736
US

IV. Provider business mailing address

708 W ESPLANADE AVE
KENNER LA
70065-2736
US

V. Phone/Fax

Practice location:
  • Phone: 504-461-9660
  • Fax: 504-461-8450
Mailing address:
  • Phone: 504-461-9660
  • Fax: 504-461-8450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GERALD ANTHONY CVITANOVICH
Title or Position: OWNER, MEDICAL DIRECTOR
Credential: M.D.
Phone: 504-461-9660