1255448973 NPI number — IBERIA GENERAL HOSPITAL AND MEDICAL CENTER

Table of content: (NPI 1255448973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255448973 NPI number — IBERIA GENERAL HOSPITAL AND MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IBERIA GENERAL HOSPITAL AND MEDICAL CENTER
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:
Provider Other Organization Name Type Code:
6
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:
1255448973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10539
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:
70562-0539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-560-1992
Provider Business Mailing Address Fax Number:
337-364-9102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2205 OLD JEANERETTE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW IBERIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70563-8687
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-560-1992
Provider Business Practice Location Address Fax Number:
337-364-9102
Provider Enumeration Date:
08/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TUCKER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT/CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
337-374-7104

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  115 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CN9239 . This is a "MEDICARE RAILROAD GROUP" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com