NPIMap

Organization Active NPI

West Jefferson Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Marrero, LA
National Provider Identifier
1487657359
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
115 Issued in LA
Legal business name
WEST JEFFERSON SURGERY CENTER, LLC
Practice address
1111 Medical Center Blvd
Ste 105N
Marrero, LA 70072-3152
Phone
(504) 349-2332
Fax
(504) 349-2359
NPI assigned
May 24, 2005
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
Mr. Mark Juneau, M.D.
Title
Medical Director
Phone
(504) 349-2332

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 115 LA Primary

Addresses

Primary practice location

1111 Medical Center Blvd
Ste 105N
Marrero, LA 70072-3152

Mailing address

1111 Medical Center Blvd
Suite 105 North
Marrero, LA 70072
Phone (504) 349-2332

Other identifiers 2

IdentifierTypeStateIssuer
1150011MedicaidLA
115OtherLALIC NUMBER

National Provider Directory

National Provider Directory

Locations

1111 Medical Center Blvd
Ste N105
Marrero, LA 70072
Phone (504) 349-2332

NPI Registry JSON

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487657359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 MEDICAL CENTER BLVD",
            "address_2": "SUITE 105 NORTH",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "70072",
            "telephone_number": "504-349-2332",
            "fax_number": "504-349-2359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 MEDICAL CENTER BLVD",
            "address_2": "STE 105N",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "700723152",
            "telephone_number": "504-349-2332",
            "fax_number": "504-349-2359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST JEFFERSON SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JUNEAU",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "504-349-2332",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "LA",
            "license": "115",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1150011",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LIC NUMBER",
            "identifier": "115",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.