1669586376 NPI number — JEFFERSON AMBULATORY SURGERY CENTER LLC

Table of content: (NPI 1669586376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669586376 NPI number — JEFFERSON AMBULATORY SURGERY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFERSON AMBULATORY SURGERY CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669586376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1207 N CAUSEWAY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70001-4129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-832-2115
Provider Business Mailing Address Fax Number:
504-832-2116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2701 LAKE VILLA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70002-6714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-274-3100
Provider Business Practice Location Address Fax Number:
504-274-3199
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TORRES
Authorized Official First Name:
TANIA
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
504-832-2115

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  139 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20373 . This is a "BLUE CROSS OF LA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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