MEDICARE: IBERIA HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1679879134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IBERIA HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 13904
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70562-3904
Country	:	US
Telephone Number	:	337-367-7889
Fax Number	:	337-376-6308

Provider Business Practice Location Address
First Line	:	115 HANSEL ST
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70560-5039
Country	:	US
Telephone Number	:	337-367-7889
Fax Number	:	337-359-8580

Authorized Official
Title or Position	:	OWNER
Name	:	MR. PAUL A BROUSSARD
Credential	:
Telephone Number	:	337-367-7889

Provider Enumeration Date	:	02/01/2011
Last Update Date	:	02/01/2011

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