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Organization

WESTSIDE CLINICS ANC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
AVERY H SAMPSON MD (MANAGING PHYSICIAN & PRESIDENT)
(504) 391-7337
Entity
Organization

Contact information

Practice address
4225 LAPALCO BLVD, MARRERO, LA 70072
(504) 391-7337
(504) 398-7213
Mailing address
P O BOX 2400, MARRERO, LA 70073-2400
(504) 391-7337
(504) 398-7213

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2080A0000X
Pediatric Adolescent Medicine Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1440574
LA
Enumeration date
08/10/2005
Last updated
06/26/2015
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