Provider Demographics
NPI:1780690180
Name:HOSPITAL SERVICE DISTRICT NO. 1 OF IBERIA PARISH
Entity Type:Organization
Organization Name:HOSPITAL SERVICE DISTRICT NO. 1 OF IBERIA PARISH
Other - Org Name:IBERIA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DIONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:VIATOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-374-7107
Mailing Address - Street 1:PO BOX 13338
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70562-3338
Mailing Address - Country:US
Mailing Address - Phone:337-374-7104
Mailing Address - Fax:337-374-7641
Practice Address - Street 1:2315 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4031
Practice Address - Country:US
Practice Address - Phone:337-374-7104
Practice Address - Fax:337-374-7641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA115282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA11212OtherBLUE CROSS
LA1796204Medicaid
LA1796204Medicaid