Healthcare Provider Details

I. General information

NPI: 1265433320
Provider Name (Legal Business Name): WESTSIDE CLINICS ANC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 06/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 LAPALCO BLVD
MARRERO LA
70072
US

IV. Provider business mailing address

P O BOX 2400
MARRERO LA
70073-2400
US

V. Phone/Fax

Practice location:
  • Phone: 504-391-7337
  • Fax: 504-398-7213
Mailing address:
  • Phone: 504-391-7337
  • Fax: 504-398-7213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: AVERY H SAMPSON
Title or Position: MANAGING PHYSICIAN & PRESIDENT
Credential: MD
Phone: 504-391-7337