Healthcare Provider Details

I. General information

NPI: 1396776837
Provider Name (Legal Business Name): WEST JEFFERSON MRI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 WESTBANK EXPY SUITE B
MARRERO LA
70072-3120
US

IV. Provider business mailing address

4525 WESTBANK EXPY SUITE B
MARRERO LA
70072-3120
US

V. Phone/Fax

Practice location:
  • Phone: 504-349-6570
  • Fax: 504-349-6195
Mailing address:
  • Phone: 504-349-6570
  • Fax: 504-349-6195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. PATRICK G. HOWARD
Title or Position: MANAGING MEMBER
Credential:
Phone: 337-291-9161