IBERIA COMPREHENSVE COMMUNITY HEALTH CENTER,INC. (NPI# 1568731602) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568731602 |
| Entity Type | Organization |
| Organization Name | IBERIA COMPREHENSVE COMMUNITY HEALTH CENTER,INC. |
| Other Organization Name | SURREY STREET COMMUNITY HEALTH CENTER #1 |
| Practice Address |
1004 Surrey St Lafayette LA 70501-6143 |
| Practice Telephone | 3374566768 |
| Practice Fax Number | 3374568690 |
| Mailing Telephone | 3374566768 |
| Mailing Fax Number | 3374568690 |
| Enumeration Date | 2011-12-19 |
| Last Update Date | 2016-05-18 |
| Authorized Official Name | MR. RODERICK CAMPBELL (CEO) |
| Authorized Official Telephone | 3373654945 |
| Authorized Official Credential | MBA |
| Is Organization Subpart | Y |
| Parent Organization Name | IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| SURREY STREET COMMUNITY HEALTH CENTER #1 | Other Name - Individual/Organization |
| Street Address |
1004 SURREY ST |
| City | LAFAYETTE |
| State | LA |
| Zip Code | 70501-6143 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356300776 | Renee B Hickson | Family Medicine | 1004 Surrey St, Lafayette, LA 70501 | 2006-03-23 |
| 1568874998 | Kimberly C Allen | Nurse Practitioner | 1004 Surrey St, Lafayette, LA 70501-6143 | 2014-05-20 |
| 1437594181 | Mary S Gathe | Social Worker | 1004 Surrey St, Lafayette, LA 70501-6143 | 2013-05-08 |
| 1851539258 | Rohini S Vicknair | Physician Assistant | 1004 Surrey St, Lafayette, LA 70501 | 2009-01-23 |
| 1891982419 | Harold Mark Borel | Dentist | 1004 Surrey St, Lafayette, LA 70501-6143 | 2007-09-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326646134 | Gifted Hands Caregiver | Home Health Aide | 213 Grimsby St., Fafayette, LA 70501 | 2020-10-14 |
| 1740888551 | Complete Count LLC | Home Health | 713 South Orange St, Lafayette, LA 70501 | 2020-10-14 |
| 1154891471 | Lesha May | Case Manager/Care Coordinator | 113 W Covent St, Lafayette, LA 70501 | 2018-11-29 |
| 1871023994 | Nancy Bass Texada | Community/Behavioral Health | 525 South Buchanan, Lafayette, LA 70501 | 2017-06-13 |
| 1447706700 | Medicine Bin Plus LLC | Pharmacy | 1105 West Willow St, Lafayette, LA 70501 | 2016-08-28 |
| 1508227968 | Vicky Marie Senegal | Home Health Aide | 304 1/2 Rubria St., Lafayette, LA 70501 | 2016-03-14 |
| 1558766931 | Corey Gerard Porche | Counselor | 708 Jefferson Blvd., Lafayette, LA 70501 | 2014-10-28 |
| 1518362219 | Sherry Riddle | Counselor | 119 Caillouet Place, Lafayette, LA 70501 | 2014-10-24 |
| 1285057893 | Hearsts of Hope | Counselor | 911 General Mouton Avenue, Lafayette, LA 70501 | 2014-02-03 |
| 1437408549 | Jensen J. Bergeron | Counselor | 600 Jefferson Street Suite 903, Lafayette, LA 70501 | 2012-09-05 |
| Find all providers in zip 70501 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891395620 | Primary Health Care Center of Dade, Inc. | Clinic/Center | 8a Probasco Street Unit 214, Lafayette, GA 30728 | 2020-10-30 |
| 1780123372 | Quality of Life Health Services, Inc | Clinic/Center | 404 9th Ave Sw, Lafayette, AL 36862-2806 | 2017-02-16 |
| 1386876233 | Riggs Community Health Center Annex | Clinic/Center | 1324 Tippecanoe St, Lafayette, IN 47904-2051 | 2009-08-11 |
| 1356530372 | Central Alabama Comprehensive Health, Inc. | Clinic/Center | 404b 9th Ave S.w., Lafayette, AL 36862 | 2007-10-16 |
| 1609120682 | Southwest Louisiana Primary Health Care Center Inc | Clinic/Center | 1800 Louisiana Ave, Lafayette, LA 70501-3702 | 2012-10-30 |
| 1316244338 | Iberia Comprehensive Community Health Center, Inc | Clinic/Center | 1002 12th St, Lafayette, LA 70501-6224 | 2011-02-28 |
| 1326214735 | Tippecanoe Community Health Clinic | Clinic/Center | 1716 Hartford St, Lafayette, IN 47904-2173 | 2008-05-06 |
| 1376725952 | Swla Center for Health Services | Clinic/Center | 500 Patterson Street, Lafayette, LA 70501 | 2007-12-05 |
| 1386660900 | Riggs Community Health Center Inc | Clinic/Center | 1716 Hartford St, Lafayette, IN 47904-2173 | 2006-07-15 |
| 1831186915 | Clinica Campesina Family Health Services | Clinic/Center | 1735 S Public Rd Ste 100, Lafayette, CO 80026-7093 | 2005-10-04 |
| Find all providers in LAFAYETTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.