Healthcare Provider Details

I. General information

NPI: 1932139193
Provider Name (Legal Business Name): IBERIA FAMILY CARE, APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E MAIN ST STE B
NEW IBERIA LA
70560-3878
US

IV. Provider business mailing address

222 E MAIN ST STE B
NEW IBERIA LA
70560-3878
US

V. Phone/Fax

Practice location:
  • Phone: 337-256-8012
  • Fax: 337-256-8037
Mailing address:
  • Phone: 337-256-8012
  • Fax: 337-256-8037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number023102
License Number StateLA

VIII. Authorized Official

Name: DR. ROBERT F HANKENHOF III
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 337-256-8012