Provider Demographics
NPI:1568731602
Name:IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER INC
Entity Type:Organization
Organization Name:IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER INC
Other - Org Name:SURREY STREET COMMUNITY HEALTH CENTER #1
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:337-365-4945
Mailing Address - Street 1:1004 SURREY ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-6143
Mailing Address - Country:US
Mailing Address - Phone:337-456-6768
Mailing Address - Fax:337-456-8690
Practice Address - Street 1:1004 SURREY ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-6143
Practice Address - Country:US
Practice Address - Phone:337-456-6768
Practice Address - Fax:337-456-8690
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-19
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)