NPIMap

Organization Active NPI

Pediatric Clinic Westbank

  • Pediatrics Physician
  • Gretna, LA
National Provider Identifier
1003904236
Registry record updated May 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
018557 Issued in LA
Legal business name
PEDIATRIC CLINIC WESTBANK
Practice address
151 Meadowcrest St Ste F
Gretna, LA 70056-5256
Phone
(504) 392-9298
Fax
(504) 392-7047
NPI assigned
Oct 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Tammy Grafe
Title
Office Manager
Phone
(504) 392-9298

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 018557 LA Primary

Addresses

Primary practice location

151 Meadowcrest St Ste F
Gretna, LA 70056-5256

Mailing address

151 Meadowcrest St Ste F
Gretna, LA 70056-5256
Phone (504) 392-9298

Other identifiers 1

IdentifierTypeStateIssuer
1945242MedicaidLA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274313600000",
    "number": "1003904236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 MEADOWCREST ST STE F",
            "city": "GRETNA",
            "state": "LA",
            "postal_code": "700565256",
            "telephone_number": "504-392-9298",
            "fax_number": "504-392-7047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 MEADOWCREST ST STE F",
            "city": "GRETNA",
            "state": "LA",
            "postal_code": "700565256",
            "telephone_number": "504-392-9298",
            "fax_number": "504-392-7047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC CLINIC WESTBANK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2010-05-20",
        "status": "A",
        "authorized_official_last_name": "GRAFE",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "504-392-9298",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "018557",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1945242",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gretna, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.