MEDICARE: IBERIA REHABILITATION HOSPITAL, LLC

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	283X00000X	Rehabilitation Hospital	561	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
2	61348	OTHER	LA	BCBS

General Provider Information

NPI Number	:	1386620045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IBERIA REHABILITATION HOSPITAL, LLC

Provider Business Mailing Address
First Line	:	532 JEFFERSON TER
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70560-4948
Country	:	US
Telephone Number	:	337-364-6923
Fax Number	:	337-364-6924

Provider Business Practice Location Address
First Line	:	532 JEFFERSON TERRRACE
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70560-4948
Country	:	US
Telephone Number	:	337-364-6923
Fax Number	:	337-364-6924

Authorized Official
Title or Position	:	PRESIDENT & COO
Name	:	MR. EUGENE E. SMITH
Credential	:
Telephone Number	:	225-216-2299

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	02/12/2009

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1649503103 — NEW IBERIA REHABILITATION HOSPITAL LLC
Practice Location Address:

532 JEFFERSON TERRACE STREET
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Practice Fax: 337-608-0362

Directions to “IBERIA REHABILITATION HOSPITAL, LLC ” Practice Location

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