Basic Information
| Provider Information | |||||||||
| NPI: | 1992359772 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JEFFCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3616 S I-10 SERVICE ROAD W. | ||||||||
| Address2: | |||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700011874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048466983 | ||||||||
| FaxNumber: | 5048385714 | ||||||||
| Practice Location | |||||||||
| Address1: | 5001 WEST BANK EXPRESSWAY | ||||||||
| Address2: | |||||||||
| City: | MARRERO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700722954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048466983 | ||||||||
| FaxNumber: | 5048385714 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2019 | ||||||||
| LastUpdateDate: | 07/30/2019 | ||||||||
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| AuthorizedOfficialLastName: | SHAW | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | DIVISION DIRECTOR JEFFCARE | ||||||||
| AuthorizedOfficialTelephone: | 5048466983 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.