Healthcare Provider Details

I. General information

NPI: 1891020012
Provider Name (Legal Business Name): IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 WALKER STREET
MERRYVILLE LA
70653
US

IV. Provider business mailing address

567 WALKER STREET
MERRYVILLE LA
70653
US

V. Phone/Fax

Practice location:
  • Phone: 337-365-4945
  • Fax: 337-367-3917
Mailing address:
  • Phone: 337-365-4945
  • Fax: 337-367-3917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. NICOLE ROBERSON
Title or Position: HEALTH INFORMATION MANAGER
Credential: MBA
Phone: 337-365-4945