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General NPI Number Information
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NPI Number | 1588624910
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Entity Type | Organization
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Legal Business Name | WOMAN'S CLINIC OF IBERIA, A PROFESSIONAL MEDICAL CORP
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 07/06/2009
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Provider Practice Location Address
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Address Line | 2309 E MAIN ST STE 500
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City | NEW IBERIA
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State | LA
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Zip | 70560-4046
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Country | US
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Telephone | 337-364-2383
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Fax | 337-365-4981
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Provider Business Mailing Address
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Address Line | 2309 E MAIN ST STE 500
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City | NEW IBERIA
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State | LA
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Zip | 70560-4046
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Country | US
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Telephone | 337-364-2383
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Fax | 337-365-4981
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. MARTHA 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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 0011446
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License Number State | LA
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