Organization
PEDIATRIC CLINIC WESTBANK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAMMY GRAFE (OFFICE MANAGER)
(504) 392-9298
Entity
Organization
Contact information
Practice address
151 MEADOWCREST ST STE F, GRETNA, LA 70056-5256
(504) 392-9298
(504) 392-7047
Mailing address
151 MEADOWCREST ST STE F, GRETNA, LA 70056-5256
(504) 392-9298
(504) 392-7047
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
018557
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1945242
—
LA
Enumeration date
10/11/2006
Last updated
05/20/2010
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