Provider Demographics
NPI:1235161043
Name:IBERIA ORTHOPEDIC GROUP A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:IBERIA ORTHOPEDIC GROUP A PROFESSIONAL CORPORATION
Other - Org Name:THE IBERIA ORTHOPEDIC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-365-8161
Mailing Address - Street 1:510 JEFFERSON TERRACE BLVD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4948
Mailing Address - Country:US
Mailing Address - Phone:337-365-8161
Mailing Address - Fax:337-365-0294
Practice Address - Street 1:510 JEFFERSON TERRACE BLVD.
Practice Address - Street 2:SUITE A
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4948
Practice Address - Country:US
Practice Address - Phone:337-365-8161
Practice Address - Fax:337-365-0294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1160733Medicaid
LA0326560001Medicare NSC
LA5B292Medicare PIN