Healthcare Provider Details

I. General information

NPI: 1255718813
Provider Name (Legal Business Name): GPN NEW IBERIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N LEWIS ST
NEW IBERIA LA
70563-2043
US

IV. Provider business mailing address

PO BOX 721981
NORMAN OK
73070-8506
US

V. Phone/Fax

Practice location:
  • Phone: 337-374-4111
  • Fax:
Mailing address:
  • Phone: 318-253-8611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SAMUEL D HUCKABEE
Title or Position: CEO
Credential:
Phone: 318-469-1132