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Organization
OUR LADY OF THE LAKE PHYSICIAN GROUP LLC
Active
Organization
OUR LADY OF THE LAKE PHYSICIAN GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY LIMBOCKER (CFO)
(225) 765-7727
Entity
Organization
Contact information
Practice address
7777 HENNESSY BLVD, STE 6002, BATON ROUGE, LA 70808-4300
(225) 765-7727
(225) 766-5645
Mailing address
2051 SILVERSIDE DR, STE 260, BATON ROUGE, LA 70808-9005
(225) 490-6301
(225) 765-9539
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
—
NULL
207K00000X
Allergy & Immunology Physician
—
—
207N00000X
Dermatology Physician
—
NULL
207N00000X
Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
207SG0201X
Clinical Genetics (M.D.) Physician
—
NULL
207SG0201X
Clinical Genetics (M.D.) Physician
—
—
207Y00000X
Otolaryngology Physician
—
NULL
207Y00000X
Otolaryngology Physician
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
—
—
208200000X
Plastic Surgery Physician
—
NULL
208200000X
Plastic Surgery Physician
—
—
2084P0800X
Psychiatry Physician
—
NULL
2084P0800X
Psychiatry Physician
—
—
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
208C00000X
Colon & Rectal Surgery Physician
—
NULL
208C00000X
Colon & Rectal Surgery Physician
—
—
208M00000X
Hospitalist Physician
—
NULL
208M00000X
Hospitalist Physician
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
10/12/2011
Last updated
10/08/2015
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