MEDICARE: IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER, INC

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1316244338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	806 JEFFERSON TER
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70560-5727
Country	:	US
Telephone Number	:	337-365-4945
Fax Number	:	337-367-3917

Provider Business Practice Location Address
First Line	:	1002 12TH ST
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70501-6224
Country	:	US
Telephone Number	:	375-340-1073
Fax Number	:	337-534-0184

Authorized Official
Title or Position	:	CFO
Name	:	MRS. MONIQUE DUMOND
Credential	:
Telephone Number	:	337-365-4945

Provider Enumeration Date	:	02/28/2011
Last Update Date	:	12/01/2021

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