| Pride Plaza | |
|
850 N Pierce St Lafayette LA 70501-2848 | |
| (337) 237-6712 | |
| (337) 234-1906 |
| Full Name | Pride Plaza |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 850 N Pierce St, Lafayette, Louisiana |
| Authorized Official Name and Position | Wartelle J Castille (OWNER / OPERATOR) |
| Authorized Official Contact | 3372376712 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pride Plaza 850 N Pierce St Lafayette LA 70501-2848 Ph: (337) 237-6712 | Pride Plaza 850 N Pierce St Lafayette LA 70501-2848 Ph: (337) 237-6712 |
| NPI Number | 1518280916 |
|---|---|
| Provider Enumeration Date | 03/12/2010 |
| Last Update Date | 03/12/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518280916 | NPI | - | NPPES |
| 1075850 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 201660 (Louisiana) | Primary |
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