| Pride Plaza Medical Llc | |
|
850 N Pierce Street Suite D Lafayette LA 70501-2848 | |
| (337) 233-2115 | |
| (337) 237-9075 |
| Full Name | Pride Plaza Medical Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 850 N Pierce Street, Lafayette, Louisiana |
| Authorized Official Name and Position | James Mwakitawa Mwatibo (PARTNER/MD) |
| Authorized Official Contact | 3372332115 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pride Plaza Medical Llc 850 N Pierce Street Suite D Lafayette LA 70501-2848 Ph: (337) 233-2115 | Pride Plaza Medical Llc 850 N Pierce Street Suite D Lafayette LA 70501-2848 Ph: (337) 233-2115 |
| NPI Number | 1790773430 |
|---|---|
| Provider Enumeration Date | 10/06/2005 |
| Last Update Date | 10/07/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790773430 | NPI | - | NPPES |
| 1443522 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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