=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003269093
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IBERIA-AMG PHYSICAL REHABILITATION HOSPITAL, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2016
-----------------------------------------------------
Last Update Date | 07/14/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 N LEWIS ST 3RD FLOOR
-----------------------------------------------------
City | NEW IBERIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70563-2043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-269-9566
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 LA RUE FRANCE SUITE 500
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70508-3144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-269-9566
-----------------------------------------------------
Fax | 337-234-1075
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | JESSICA L MCGEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 337-269-9566
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283X00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------