Provider Demographics
NPI:1801121942
Name:OUR LADY OF LOURDES PRIMARY CARE NETWORK
Entity type:Organization
Organization Name:OUR LADY OF LOURDES PRIMARY CARE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIGITTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GIROUARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-837-2664
Mailing Address - Street 1:805 ALBERTSON PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-4350
Mailing Address - Country:US
Mailing Address - Phone:337-837-2664
Mailing Address - Fax:337-837-2551
Practice Address - Street 1:805 ALBERTSON PKWY STE B
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-4350
Practice Address - Country:US
Practice Address - Phone:337-837-2664
Practice Address - Fax:337-837-2551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA202732207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1205044757OtherDR'S NPI
LA1505706Medicaid
LA1801121942OtherGROUP NPI
LA1801121942OtherGROUP NPI