Provider Demographics
NPI:1588624910
Name:WOMAN'S CLINIC OF IBERIA, A PROFESSIONAL MEDICAL CORP
Entity Type:Organization
Organization Name:WOMAN'S CLINIC OF IBERIA, A PROFESSIONAL MEDICAL CORP
Other - Org Name:THE WOMAN'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:COPPAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-364-2383
Mailing Address - Street 1:2309 E MAIN ST
Mailing Address - Street 2:STE 500
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4046
Mailing Address - Country:US
Mailing Address - Phone:337-364-2383
Mailing Address - Fax:337-365-4981
Practice Address - Street 1:2309 E MAIN ST
Practice Address - Street 2:STE 500
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4046
Practice Address - Country:US
Practice Address - Phone:337-364-2383
Practice Address - Fax:337-365-4981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0011446174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1375888Medicaid
LA1154806Medicaid
LA1664847Medicaid
LA1157562Medicaid
LA1137189Medicaid
LAB89503Medicare UPIN
LA51666Medicare ID - Type Unspecified
LA52154Medicare ID - Type Unspecified
LA1137189Medicaid
LA1664847Medicaid
LA52107Medicare ID - Type Unspecified
LA5W337Medicare ID - Type Unspecified
LA4F243Medicare ID - Type Unspecified
LA1154806Medicaid
LA1375888Medicaid