Provider Demographics
NPI:1902094279
Name:IBERVILLE PARISH SCHOOL BOARD
Entity Type:Organization
Organization Name:IBERVILLE PARISH SCHOOL BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-749-2360
Mailing Address - Street 1:58030 PLAQUEMINE ST
Mailing Address - Street 2:
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-2522
Mailing Address - Country:US
Mailing Address - Phone:225-749-2360
Mailing Address - Fax:
Practice Address - Street 1:58030 PLAQUEMINE ST
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-2522
Practice Address - Country:US
Practice Address - Phone:225-749-2360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1701637Medicaid