Healthcare Provider Details

I. General information

NPI: 1255448973
Provider Name (Legal Business Name): IBERIA GENERAL HOSPITAL AND MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 OLD JEANERETTE RD
NEW IBERIA LA
70563-8687
US

IV. Provider business mailing address

PO BOX 10539
NEW IBERIA LA
70562-0539
US

V. Phone/Fax

Practice location:
  • Phone: 337-560-1992
  • Fax: 337-364-9102
Mailing address:
  • Phone: 337-560-1992
  • Fax: 337-364-9102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number115
License Number StateLA

VIII. Authorized Official

Name: MR. JOHN A TUCKER
Title or Position: PRESIDENT/CHIEF EXECUTIVE OFFICER
Credential: FACHE
Phone: 337-374-7104