MEDICARE: WOMAN'S CLINIC OF IBERIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization	022088	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215372594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMAN'S CLINIC OF IBERIA

Provider Business Mailing Address
First Line	:	2309 EAST MAIN STREET
Second Line	:	SUITE 500
City	:	NEW IBERIA
State	:	LA
Zip	:	70560
Country	:	US
Telephone Number	:	337-364-2383
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 ALBERTSON PKWY
Second Line	:	SUITE F
City	:	BROUSSARD
State	:	LA
Zip	:	70518-5256
Country	:	US
Telephone Number	:	337-330-2386
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. MARTTHA L COPPAGE
Credential	:	M.D.
Telephone Number	:	337-364-2383

Provider Enumeration Date	:	05/01/2013
Last Update Date	:	05/06/2013

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Directions to “WOMAN'S CLINIC OF IBERIA ” Practice Location

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