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General NPI Number Information
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NPI Number | 1215372594
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Entity Type | Organization
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Legal Business Name | WOMAN'S CLINIC OF IBERIA
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Dates
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Enumeration Date | 05/01/2013
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Last Update Date | 05/06/2013
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Provider Practice Location Address
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Address Line | 811 ALBERTSON PKWY SUITE F
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City | BROUSSARD
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State | LA
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Zip | 70518-5256
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Country | US
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Telephone | 337-330-2386
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Fax |
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Provider Business Mailing Address
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Address Line | 2309 EAST MAIN STREET SUITE 500
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City | NEW IBERIA
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State | LA
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Zip | 70560
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Country | US
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Telephone | 337-364-2383
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. MARTTHA L COPPAGE
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Credential | M.D.
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Telephone | 337-364-2383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 022088
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License Number State | LA
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