# OUR LADY OF THE LAKE PHYSICIAN GROUP, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Our Lady of the Lake Physician Group-Riverside
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134152630
- **Authorized official:** JAMY A RICHARD (VP FINANCE)
- **Authorized official phone:** (225) 526-0121

## Contact information

- **Practice address:** 18740 HIGHWAY 22, MAUREPAS, LA 70449-3018
- **Practice address phone:** (225) 698-3435
- **Practice address fax:** (225) 698-6446
- **Mailing address:** 18740 HIGHWAY 22, MAUREPAS, LA 70449-3018
- **Mailing address phone:** (225) 698-3435
- **Mailing address fax:** (225) 698-6446

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |
| 261QR1300X | Rural Health Clinic/Center | 115 | LA | Yes |

## Other

- **Enumeration date:** 07/08/2006
- **Last updated:** 03/01/2017