Provider Demographics
NPI:1033187778
Name:IBERIA GENERAL HOSPITAL & MEDICAL CENTER
Entity Type:Organization
Organization Name:IBERIA GENERAL HOSPITAL & MEDICAL CENTER
Other - Org Name:IBERIA MEDICAL CENTER HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-374-7104
Mailing Address - Street 1:2313 E MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4091
Mailing Address - Country:US
Mailing Address - Phone:337-364-4422
Mailing Address - Fax:337-364-9955
Practice Address - Street 1:2313 E MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4091
Practice Address - Country:US
Practice Address - Phone:337-364-4422
Practice Address - Fax:337-364-9955
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IBERIA GENERAL HOSPITAL & MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-09
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA774251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1406261Medicaid
LA34317OtherBLUE CROSS
LA197718Medicare Oscar/Certification