Healthcare Provider Details

I. General information

NPI: 1518935220
Provider Name (Legal Business Name): HOSPITAL SERVICE DISTRICT NO. 1 OF IBERIA PARISH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 BOURG ST
JEANERETTE LA
70544-3503
US

IV. Provider business mailing address

217 BOURG ST
JEANERETTE LA
70544-3503
US

V. Phone/Fax

Practice location:
  • Phone: 337-276-7002
  • Fax: 337-276-3700
Mailing address:
  • Phone: 337-276-7002
  • Fax: 337-276-3700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number052
License Number StateLA

VIII. Authorized Official

Name: MRS. DIONNE VIATOR
Title or Position: CFO/INTERIM CEO
Credential:
Phone: 337-374-7107