1316244338 NPI number — IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER, INC

Table of content: (NPI 1316244338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316244338 NPI number — IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SURREY STREET COMMUNITY HEALTH CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316244338
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
806 JEFFERSON TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW IBERIA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70560-5727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-365-4945
Provider Business Mailing Address Fax Number:
337-367-3917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1002 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70501-6224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
375-340-1073
Provider Business Practice Location Address Fax Number:
337-534-0184
Provider Enumeration Date:
02/28/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DUMOND
Authorized Official First Name:
MONIQUE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
337-365-4945

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)