MEDICARE: WEST JEFFERSON HOLDINGS, 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	282N00000X	General Acute Care Hospital	236	LA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265437644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST JEFFERSON HOLDINGS, LLC

Provider Business Mailing Address
First Line	:	1101 MEDICAL CENTER BLVD
Second Line	:
City	:	MARRERO
State	:	LA
Zip	:	70072-3147
Country	:	US
Telephone Number	:	504-349-1202
Fax Number	:	504-349-1334

Provider Business Practice Location Address
First Line	:	1101 MEDICAL CENTER BLVD
Second Line	:
City	:	MARRERO
State	:	LA
Zip	:	70072-3147
Country	:	US
Telephone Number	:	504-349-1202
Fax Number	:	504-349-1334

Authorized Official
Title or Position	:	SR DIR OF INTEGRATED HEALTH MGMT
Name	:	MRS. ANGELA GREENER
Credential	:
Telephone Number	:	504-349-6021

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	04/07/2016

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