# OUR LADY OF THE LAKE HOSPITAL INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** OUR LADY OF THE LAKE HOSPITAL INC
- **Other names:** Lake Primary Care Physicians
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1275577603
- **Legal business name:** OUR LADY OF THE LAKE HOSPITAL INC
- **Authorized official:** MS. JAMY RICHARD (DIR OF REIMBURSEMENT AND FINANCE)
- **Authorized official phone:** (225) 765-4281

## Contact information

- **Practice address:** 8415 GOODWOOD BLVD, SUITE 105, BATON ROUGE, LA 70806-7851
- **Practice address phone:** (225) 765-5727
- **Practice address fax:** (225) 765-9244
- **Mailing address:** 8415 GOODWOOD BLVD, SUITE 105, BATON ROUGE, LA 70806-7851
- **Mailing address phone:** (225) 765-5727
- **Mailing address fax:** (225) 765-9244

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 207RG0300X | Geriatric Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RG0300X | Geriatric Medicine (Internal Medicine) Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |

## Other

- **Enumeration date:** 06/15/2006
- **Last updated:** 04/15/2011