Healthcare Provider Details

I. General information

NPI: 1639027063
Provider Name (Legal Business Name): IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SURREY ST
LAFAYETTE LA
70501-7752
US

IV. Provider business mailing address

806 JEFFERSON TER
NEW IBERIA LA
70560-5727
US

V. Phone/Fax

Practice location:
  • Phone: 337-365-4945
  • Fax:
Mailing address:
  • Phone: 337-365-4945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: REGINALD BOUTTE
Title or Position: PHARMACIST
Credential: R. PH
Phone: 337-365-4945