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Organization
OUR LADY OF THE LAKE PHYSICIAN GROUP LLC
Active
Organization
OUR LADY OF THE LAKE PHYSICIAN GROUP LLC
Active
Parent organization
OUR LADY OF THE LAKE HOSPITAL INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
OUR LADY OF THE LAKE HOSPITAL INC
Authorized official
ELONA SHARBAUGH (VP PHYSICIAN PRACTICES)
(225) 490-8806
Entity
Organization
Contact information
Practice address
230 ROBERTS DR, SUITE B, NEW ROADS, LA 70760-2661
(225) 638-8661
(225) 638-2977
Mailing address
2051 SILVERSIDE DR, SUITE 120, BATON ROUGE, LA 70808-9005
(225) 765-4226
(225) 765-9244
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
Other
Enumeration date
02/06/2007
Last updated
12/10/2012
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