| St Michaels Clinic | |
|
2309 E Main St Ste 201 New Iberia LA 70560-4046 | |
| (337) 335-0240 | |
| Not Available |
| Full Name | St Michaels Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 2309 E Main St Ste 201, New Iberia, Louisiana |
| Authorized Official Name and Position | Ronald Tyler Hebert (OWNER) |
| Authorized Official Contact | 3373393274 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St Michaels Clinic 715 E Main St New Iberia LA 70560-3823 Ph: (337) 339-3274 | St Michaels Clinic 2309 E Main St Ste 201 New Iberia LA 70560-4046 Ph: (337) 335-0240 |
| NPI Number | 1255178067 |
|---|---|
| Provider Enumeration Date | 07/09/2024 |
| Last Update Date | 07/09/2024 |
| Certification Date | 07/09/2024 |
| Medicare PECOS PAC ID | 2860932084 |
|---|---|
| Medicare Enrollment ID | O20240913001938 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255178067 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Primary |
| Provider Name | Ronald Tyler Hebert |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003310897 PECOS PAC ID: 6507290020 Enrollment ID: I20191216002476 |
| Provider Name | Lena Broussard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861348658 PECOS PAC ID: 6406323179 Enrollment ID: I20260430000939 |
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