Provider Demographics
NPI:1780033068
Name:FMC ASSOCIATES OF NEW IBERIA
Entity Type:Organization
Organization Name:FMC ASSOCIATES OF NEW IBERIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-367-0271
Mailing Address - Street 1:2309 E MAIN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4046
Mailing Address - Country:US
Mailing Address - Phone:337-367-0271
Mailing Address - Fax:337-364-6139
Practice Address - Street 1:2309 E MAIN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4046
Practice Address - Country:US
Practice Address - Phone:337-367-0271
Practice Address - Fax:337-364-6139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015812207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1333093Medicaid
LAB60884Medicare UPIN