Provider Demographics
NPI:1679879134
Name:IBERIA HEALTHCARE LLC
Entity Type:Organization
Organization Name:IBERIA HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-367-7889
Mailing Address - Street 1:PO BOX 13904
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70562-3904
Mailing Address - Country:US
Mailing Address - Phone:337-367-7889
Mailing Address - Fax:337-376-6308
Practice Address - Street 1:115 HANSEL ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-5039
Practice Address - Country:US
Practice Address - Phone:337-367-7889
Practice Address - Fax:337-359-8580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health