Provider Demographics
NPI:1174825202
Name:OUR LADY OF LOURDES DBA JAMES MWATIBO, M.D.
Entity Type:Organization
Organization Name:OUR LADY OF LOURDES DBA JAMES MWATIBO, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLILAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BARROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-289-2000
Mailing Address - Street 1:850 N PIERCE ST STE D
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-2848
Mailing Address - Country:US
Mailing Address - Phone:337-233-2115
Mailing Address - Fax:337-237-9075
Practice Address - Street 1:850 N PIERCE ST STE D
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-2848
Practice Address - Country:US
Practice Address - Phone:337-233-2115
Practice Address - Fax:337-237-9075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14561R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty