Provider Demographics
NPI:1417349432
Name:IBERVILLE HEALTH, LLC
Entity Type:Organization
Organization Name:IBERVILLE HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:POYEE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-687-2001
Mailing Address - Street 1:59295 RIVER WEST DR STE C
Mailing Address - Street 2:
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-6597
Mailing Address - Country:US
Mailing Address - Phone:225-687-2001
Mailing Address - Fax:225-687-9519
Practice Address - Street 1:59295 RIVER WEST DR STE C
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-6597
Practice Address - Country:US
Practice Address - Phone:225-687-2001
Practice Address - Fax:225-687-9519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health