Organization
WEST JEFFERSON SURGERY CENTER LLC
Active
Other names
Gwen McInnis Administrator
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GWENDOLYN MORVANT MCINNIS RN MHA (ADMINISTRATOR)
(504) 349-6017
Entity
Organization
Contact information
Practice address
1111 MEDICAL CENTER BLVD, STE 105 NORTH, MARRERO, LA 70072
(504) 349-2332
(504) 349-2359
Mailing address
1111 MEDICAL CENTER BLVD, STE 105 NORTH, MARRERO, LA 70072
(504) 349-2332
(504) 349-2359
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115
LIC
—
05
—
1150011
—
LA
01
—
A50004330
STATE
—
Enumeration date
09/07/2005
Last updated
08/22/2020
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