Healthcare Provider Details

I. General information

NPI: 1366517351
Provider Name (Legal Business Name): WJH PHYSICIAN SERVICES D/B/A WEST JEFFERSON PHYSICIANS SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MEDICAL CENTER BLVD PEDIATRIC ER
MARRERO LA
70072-3147
US

IV. Provider business mailing address

1101 MEDICAL CENTER BLVD ATTN: HEIDI GWINN
MARRERO LA
70072-3147
US

V. Phone/Fax

Practice location:
  • Phone: 504-349-1555
  • Fax: 504-349-1146
Mailing address:
  • Phone: 504-349-1555
  • Fax: 504-349-1146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: HEIDI A GWINN
Title or Position: CREDENTIALING COORD.
Credential:
Phone: 504-349-1297