WEST JEFFERSON PHYSICIAN SERVICES (NPI# 1669549283) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669549283 |
| Entity Type | Organization |
| Organization Name | WEST JEFFERSON PHYSICIAN SERVICES |
| Other Organization Name | PEDIATRIC SPECIALTY |
| Practice Address |
1111 Medical Center Blvd Suite S650 Marrero LA 70072-3151 |
| Practice Telephone | 5043496504 |
| Practice Fax Number | 5043496528 |
| Mailing Telephone | 5043496504 |
| Mailing Fax Number | 5043496528 |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | HEIDI A GWINN (CREDENTIALING COORD.) |
| Authorized Official Telephone | 5043491297 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 2080P0201X |
Pediatrics Specialization: Pediatric Allergy/Immunology |
Allopathic & Osteopathic Physicians | ||
| X | 2080P0206X |
Pediatrics Specialization: Pediatric Gastroenterology |
Allopathic & Osteopathic Physicians | ||
| X | 2080P0214X |
Pediatrics Specialization: Pediatric Pulmonology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1942545 | 05 |
| Other Name | Type Code |
|---|---|
| Pediatric Specialty | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780015784 | West Jefferson Physician Services | Nutritionist | 1121 Medical Center Blvd., West Jefferson Fitness Center, Marrero, LA 70072 | 2013-12-02 |
| 1831266162 | West Jefferson Physician Services | Family Medicine | 5140 Church St, Lafitte, LA 70067-5256 | 2006-11-30 |
| 1790850774 | West Jefferson Physician Services | Family Medicine | 3909 Lapalco Blvd, Suite 100, Harvey, LA 70058-2302 | 2006-11-22 |
| 1053486043 | West Jefferson Physician Services | Internal Medicine | 1111 Medical Center Blvd, Suite S850, Marrero, LA 70072-3151 | 2006-11-22 |
| 1114092194 | West Jefferson Physician Services | Internal Medicine | 2845 Manhattan Blvd, Harvey, LA 70058-2987 | 2006-11-22 |
| 1457426439 | West Jefferson Physician Services | Family Medicine | 175 Hector Ave, Gretna, LA 70056-2590 | 2006-11-22 |
| Street Address |
1111 MEDICAL CENTER BLVD SUITE S650 |
| City | MARRERO |
| State | LA |
| Zip Code | 70072-3151 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487657359 | West Jefferson Surgery Center, LLC | Clinic/Center | 1111 Medical Center Blvd, Ste 105n, Marrero, LA 70072-3152 | 2005-05-24 |
| 1972129211 | Marissa Liantonio Miller | Nurse Practitioner | 1111 Medical Center Blvd, Marrero, LA 70072-3151 | 2020-06-23 |
| 1952920324 | Kirstie Rae Schieffler | Physician Assistant | 1111 Medical Center Blvd, Marrero, LA 70072-3151 | 2020-04-15 |
| 1841730918 | Samantha Schenker | Nurse Practitioner | 1111 Medical Center Blvd, N406, Marrero, LA 70072-3151 | 2017-03-08 |
| 1376092379 | Shelli Rodriguez Ergen | Nurse Practitioner | 1111 Medical Center Blvd, Suite South 113, Marrero, LA 70072-3151 | 2016-10-02 |
| 1326418443 | Cain Foot Center, LLC | Podiatrist | 1111 Medical Center Blvd, Suite N-313, Marrero, LA 70072-3151 | 2015-10-01 |
| 1235515693 | Joseph Guarnieri | Eyewear Supplier (Equipment, not the service) | 1111 Medical Center Blvd, Suite N-114, Marrero, LA 70072-3151 | 2015-08-07 |
| 1639552979 | Kelly Thibodeaux | Nurse Practitioner | 1111 Medical Center Blvd, 350s, Marrero, LA 70072-3151 | 2015-07-06 |
| 1629478409 | Ochsner Clinic LLC | General Practice | 1111 Medical Center Blvd, Suite 313n, Marrero, LA 70072-3151 | 2014-08-28 |
| 1285034553 | Raven S Jackson | Pharmacist | 1111 Medical Center Blvd, S 850, Marrero, LA 70072-3151 | 2014-08-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780232579 | Brittany Inez Young | Technician | 4465 Bay View Drive, Marrero, LA 70072 | 2019-08-27 |
| 1356829774 | Zachary Allen Runge Kleinpeter | Physician Assistant | 1111 Medical Center Blvd Ste S630, Marrero, LA 70072 | 2018-07-30 |
| 1689172611 | Derron White | Specialist | 2324 Barataria Blvd, Marrero, LA 70072 | 2018-01-24 |
| 1477064616 | Bone & Joint, LLC Physical Therapy | Physical Therapist | 4633 Wichers Dr., Marrero, LA 70072 | 2017-10-16 |
| 1477077410 | Darlene Jenkins | Case Manager/Care Coordinator | 7606 Westbank Expy Ste B, Marrero, LA 70072 | 2017-08-01 |
| 1871017186 | Tyra K Haynes | Non-emergency Medical Transport (VAN) | 536 Westwood Drive, Marrero, LA 70072 | 2017-07-28 |
| 1265961536 | Danika Kayelle Frank | Social Worker | 6189 Boutte St, Marrero, LA 70072 | 2017-06-08 |
| 1528596673 | Monica Cheree Mayberry | Counselor | 931 Westwood Dr., Marrero, LA 70072 | 2017-06-01 |
| 1710419197 | Sharla Black | Counselor | 2069 Paine Drive, Marrero, LA 70072 | 2017-04-03 |
| 1699207043 | Tango Austin | Counselor | 2573 Foliage Drive, Marrero, LA 70072 | 2017-04-03 |
| Find all providers in zip 70072 | ||||
| Taxonomy Code | 2080P0201X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Allergy/Immunology |
| A pediatrician who specializes in the diagnosis and treatment of allergies, allergic reactions, and immunologic diseases in children. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: title modified, definition added, source added] Additional Resources: A Certification of Special Qualifications (CSQ) is issued by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215923669 | Emilio J Saturno | Pediatrics | 1111 Medical Center Blvd, Suite S650, Marrero, LA 70072-3151 | 2005-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962679001 | Iraj Shadravan | Pediatrics | 1342 Marc Antony Dr, Baton Rouge, LA 70816-1946 | 2008-05-08 |
| 1447518246 | Andrew Abreo | Pediatrics | 200 Henry Clay Ave, New Orleans, LA 70118 | 2012-04-30 |
| 1396837845 | Jane Maroney Sayem El-dahr | Pediatrics | 1415 Tulane Ave, New Orleans, LA 70112-2600 | 2006-09-29 |
| 1073521647 | Tonya Maria Clayton | Pediatrics | 1501 Kings Hwy, Department of Pediatrics, Shreveport, LA 71103-4228 | 2006-08-03 |
| 1386665305 | Augusto C. Ochoa | Pediatrics | 200 Henry Clay Ave, New Orleans, LA 70118-5720 | 2006-07-23 |
| 1902823966 | Sami Labib Bahna | Pediatrics | 1501 Kings Hwy, Department of Pediatric, Section of Allergy & Immunolog, Shreveport, LA 71103-4228 | 2006-07-16 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.