Provider Demographics
NPI:1518935220
Name:HOSPITAL SERVICE DISTRICT NO. 1 OF IBERIA PARISH
Entity Type:Organization
Organization Name:HOSPITAL SERVICE DISTRICT NO. 1 OF IBERIA PARISH
Other - Org Name:JEANERETTE RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/INTERIM CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:VIATOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-374-7107
Mailing Address - Street 1:217 BOURG ST
Mailing Address - Street 2:
Mailing Address - City:JEANERETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70544-3503
Mailing Address - Country:US
Mailing Address - Phone:337-276-7002
Mailing Address - Fax:337-276-3700
Practice Address - Street 1:217 BOURG ST
Practice Address - Street 2:
Practice Address - City:JEANERETTE
Practice Address - State:LA
Practice Address - Zip Code:70544-3503
Practice Address - Country:US
Practice Address - Phone:337-276-7002
Practice Address - Fax:337-276-3700
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL SERVICE DISTRICT NO. 1 OF IBERIA PARISH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-09
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA052261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA11212OtherBLUE CROSS
LA1944637Medicaid
LA193404Medicare Oscar/Certification