# OUR LADY OF THE LAKE PHYSICIAN GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** OUR LADY OF THE LAKE HOSPITAL INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1447399308
- **Legal business name:** OUR LADY OF THE LAKE HOSPITAL INC
- **Authorized official:** JAMY RICHARD (VP FINANCE)
- **Authorized official phone:** (225) 490-8801

## Contact information

- **Practice address:** 310 DUREL DR, NEW ROADS, LA 70760-2973
- **Practice address phone:** (225) 713-2400
- **Practice address fax:** (225) 713-2405
- **Mailing address:** 5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
- **Mailing address phone:** (225) 526-0006
- **Mailing address fax:** (225) 765-9291

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363LF0000X | Family Nurse Practitioner | AP07361 | LA | — |

## Other

- **Enumeration date:** 02/06/2007
- **Last updated:** 07/28/2016