Pride Plaza Medical LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PRIDE PLAZA MEDICAL LLC

Practice address

850 N Pierce Street
Suite D
Lafayette, LA 70501-2848

Phone

(337) 233-2115

Fax

(337) 237-9075

NPI assigned

Oct 6, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. James Mwakitawa Mwatibo, MD, PHD

Title

Partner/MD

Phone

(337) 233-2115

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Stephens Johnny J Member Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286409600000",
    "number": "1790773430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 N PIERCE STREET",
            "address_2": "SUITE D",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705012848",
            "telephone_number": "337-233-2115",
            "fax_number": "337-237-9075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 N PIERCE STREET",
            "address_2": "SUITE D",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705012848",
            "telephone_number": "337-233-2115",
            "fax_number": "337-237-9075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIDE PLAZA MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-06",
        "last_updated": "2010-10-07",
        "status": "A",
        "authorized_official_last_name": "MWATIBO",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "MWAKITAWA",
        "authorized_official_title_or_position": "PARTNER/MD",
        "authorized_official_telephone_number": "337-233-2115",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, PHD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1443522",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stephens Johnny J Member",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Lafayette, LA
• Family Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.