NPIMap

Organization Active NPI

West Jefferson Physician Services

Doing business as Family Doctors

  • Internal Medicine Physician
  • Marrero, LA
National Provider Identifier
1053486043
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
WEST JEFFERSON PHYSICIAN SERVICES
Doing business as
Family Doctors
Practice address
1111 Medical Center Blvd
Suite S850
Marrero, LA 70072-3151
Phone
(504) 349-6450
Fax
(504) 349-6454
NPI assigned
Nov 22, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Heidi A Gwinn
Title
Credentialing Coord.
Phone
(504) 349-1297

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

1111 Medical Center Blvd
Suite S850
Marrero, LA 70072-3151

Mailing address

1111 Medical Center Blvd
Suite S850
Marrero, LA 70072-3151
Phone (504) 349-6450

Other identifiers 1

IdentifierTypeStateIssuer
1942545MedicaidLA

Other names 1

  • Family Doctors Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D0906941Family Doctors Pob, the1111 Medical Center Blvd S-850, Marrero, LA 70072Certificate of waiverFeb 28, 2027

National Provider Directory

National Provider Directory
Tax ID family
Family Doctors7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1111 Medical Center Blvd
Ste S850
Marrero, LA 70072
Phone (504) 349-6450

NPI Registry JSON

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053486043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 MEDICAL CENTER BLVD",
            "address_2": "SUITE S850",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "700723151",
            "telephone_number": "504-349-6450",
            "fax_number": "504-349-6454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 MEDICAL CENTER BLVD",
            "address_2": "SUITE S850",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "700723151",
            "telephone_number": "504-349-6450",
            "fax_number": "504-349-6454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST JEFFERSON PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GWINN",
        "authorized_official_first_name": "HEIDI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CREDENTIALING COORD.",
        "authorized_official_telephone_number": "504-349-1297"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1942545",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Doctors",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marrero, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.