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General NPI Number Information
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NPI Number | 1437042959
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Entity Type | Organization
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Legal Business Name | ST. JOSEPH'S CLINIC OF LOUISIANA
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 1409 CHURCH ST
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City | JEANERETTE
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State | LA
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Zip | 70544-4407
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Country | US
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Telephone | 337-276-6018
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Fax | 337-901-5805
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Provider Business Mailing Address
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Address Line | 302 HACKER ST
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City | NEW IBERIA
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State | LA
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Zip | 70560-4508
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Country | US
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Telephone | 337-330-2576
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Fax | 337-321-6295
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | ANTOINETTE RABENALDT
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Credential |
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Telephone | 337-330-2576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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