Basic Information
| Provider Information | |||||||||
| NPI: | 1376185702 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | IBH HOLDING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 POYDRAS ST STE 1950 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701303341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043223837 | ||||||||
| FaxNumber: | 5043223847 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 POYDRAS ST STE 1950 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701303341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043223837 | ||||||||
| FaxNumber: | 5043223847 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2019 | ||||||||
| LastUpdateDate: | 10/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | MORSON | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 5043223837 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 1619310257 | 01 | LA | PSYCHIATRY | OTHER | 1932309325 | 01 | LA | PSYCHIATRY | OTHER | 1780882118 | 01 | LA | PSYCHIATRY | OTHER | 1922443381 | 01 | LA | PSYCHIATRY | OTHER | 1487911392 | 01 | LA | PSYCHIATRY | OTHER |