NPIMap

Organization Active NPI

West Jefferson Physician Services

  • Nutritionist
  • Marrero, LA
National Provider Identifier
1780015784
Registry record updated Dec 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
NutritionistTaxonomy code 133N00000X
Legal business name
WEST JEFFERSON PHYSICIAN SERVICES
Practice address
1121 Medical Center Blvd.
West Jefferson Fitness Center
Marrero, LA 70072
Phone
(504) 348-0055
Fax
(504) 347-4267
NPI assigned
Dec 2, 2013
Last updated
Dec 2, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2013

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

Authorized official

Name
Mrs. Angela Greener
Title
Chief Administrative Officer
Phone
(504) 349-6021

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
NutritionistGroup: 193200000X MULTI-SPECIALTY GROUP 133N00000X Primary

Addresses

Primary practice location

1121 Medical Center Blvd.
West Jefferson Fitness Center
Marrero, LA 70072

Mailing address

1101 Medical Center Blvd.
Attn: Heidi Gwinn
Marrero, LA 70072
Phone (504) 349-1297

Other identifiers 1

IdentifierTypeStateIssuer
1942545MedicaidLA

Other names 1

  • West Jefferson Diabetes Prevention Program Other name

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

1121 Medical Center Blvd
Marrero, LA 70072
Phone (504) 348-0055

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1385942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385942400000",
    "number": "1780015784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 MEDICAL CENTER BLVD.",
            "address_2": "ATTN: HEIDI GWINN",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "70072",
            "telephone_number": "504-349-1297",
            "fax_number": "504-349-1146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 MEDICAL CENTER BLVD.",
            "address_2": "WEST JEFFERSON FITNESS CENTER",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "70072",
            "telephone_number": "504-348-0055",
            "fax_number": "504-347-4267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST JEFFERSON PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-02",
        "last_updated": "2013-12-02",
        "status": "A",
        "authorized_official_last_name": "GREENER",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "504-349-6021",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1942545",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Jefferson Diabetes Prevention Program",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Dec 2, 2013; 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.