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Organization
OUR LADY OF THE LAKE PHYSICIAN GROUP LLC
Active
Organization
OUR LADY OF THE LAKE PHYSICIAN GROUP LLC
Active
Other names
Pediatric Emergency Services
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
7777 HENNESSY BLVD, STE 6002, BATON ROUGE, LA 70808-4300
(225) 765-7727
(225) 766-5645
Taxonomy
Speciality
Code
Description
License number
State
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
—
NULL
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
—
—
Other
Enumeration date
10/12/2011
Last updated
10/12/2011
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