Provider Demographics
NPI:1932231065
Name:TECHE OCCUPATIONAL MEDICINE CLINIC
Entity Type:Organization
Organization Name:TECHE OCCUPATIONAL MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:337-560-0931
Mailing Address - Street 1:2309 E MAIN ST
Mailing Address - Street 2:BLDG B
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4046
Mailing Address - Country:US
Mailing Address - Phone:337-560-0931
Mailing Address - Fax:337-560-0934
Practice Address - Street 1:2309 E MAIN ST
Practice Address - Street 2:BLDG B
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4046
Practice Address - Country:US
Practice Address - Phone:337-560-0931
Practice Address - Fax:337-560-0934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11027053261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA=========OtherTAX ID