Provider Demographics
NPI:1932152626
Name:EAST JEFFERSON AFTER HOURS, LLC
Entity type:Organization
Organization Name:EAST JEFFERSON AFTER HOURS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CVITANOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-461-9660
Mailing Address - Street 1:708 W ESPLANADE AVE
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2736
Mailing Address - Country:US
Mailing Address - Phone:504-461-9660
Mailing Address - Fax:504-461-8450
Practice Address - Street 1:708 W ESPLANADE AVE
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2736
Practice Address - Country:US
Practice Address - Phone:504-461-9660
Practice Address - Fax:504-461-8450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CC22Medicare ID - Type UnspecifiedMEDICARE FACILITY