Provider Demographics
NPI:1639147085
Name:IBERIA GENERAL HOSPITAL & MEDICAL CENTER
Entity Type:Organization
Organization Name:IBERIA GENERAL HOSPITAL & MEDICAL CENTER
Other - Org Name:THE CHILDREN'S PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:YOUREE
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:337-374-7104
Mailing Address - Street 1:PO BOX 9196
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70562-9196
Mailing Address - Country:US
Mailing Address - Phone:337-560-5005
Mailing Address - Fax:337-560-9757
Practice Address - Street 1:2308 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4032
Practice Address - Country:US
Practice Address - Phone:337-560-5005
Practice Address - Fax:337-560-9757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2020-08-22
Deactivation Date:2006-06-05
Deactivation Code:
Reactivation Date:2006-07-26
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1444022Medicaid
LA1444022Medicaid