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General NPI Number Information
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NPI Number | 1922046549
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Entity Type | Organization
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Legal Business Name | IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER,INC.
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 806 JEFFERSON TER
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City | NEW IBERIA
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State | LA
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Zip | 70562-5727
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Country | US
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Telephone | 337-365-4945
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Fax |
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Provider Business Mailing Address
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Address Line | 806 JEFFERSON TER
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City | NEW IBERIA
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State | LA
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Zip | 70562-5727
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Country | US
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Telephone | 337-365-4945
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. RODERICK CAMPBELL
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Credential | MBA/HCA
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Telephone | 337-365-4945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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