Provider Demographics
NPI:1366417248
Name:OCCUPATIONAL MEDICINE CENTER OF WEST JEFFERSON
Entity type:Organization
Organization Name:OCCUPATIONAL MEDICINE CENTER OF WEST JEFFERSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-347-8471
Mailing Address - Street 1:4475 WESTBANK EXPY
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4475 WESTBANK EXPY
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3102
Practice Address - Country:US
Practice Address - Phone:504-347-8471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty