Provider Demographics
NPI:1881631497
Name:NEW IBERIA SURGERY CENTER LLC
Entity Type:Organization
Organization Name:NEW IBERIA SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:MENCACCI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:337-560-9622
Mailing Address - Street 1:2309 E MAIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4046
Mailing Address - Country:US
Mailing Address - Phone:337-560-1801
Mailing Address - Fax:
Practice Address - Street 1:2309 E MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4046
Practice Address - Country:US
Practice Address - Phone:337-560-1801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1438545Medicaid
LA11072Medicare PIN