Provider Demographics
NPI:1316244338
Name:IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER, INC
Entity type:Organization
Organization Name:IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-365-4945
Mailing Address - Street 1:806 JEFFERSON TER
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-5727
Mailing Address - Country:US
Mailing Address - Phone:337-365-4945
Mailing Address - Fax:337-367-3917
Practice Address - Street 1:1002 12TH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-6224
Practice Address - Country:US
Practice Address - Phone:375-340-1073
Practice Address - Fax:337-534-0184
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-28
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)