# ASHLEY RIDGE MEDICINE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922294784
- **Authorized official:** CHI TAI PETER LAU M. D. (PHYSICIAN / PROVIDER / OWNER)
- **Authorized official phone:** (318) 645-6161

## Contact information

- **Practice address:** 1015 OBRIE ST, ZWOLLE, LA 71486-2510
- **Practice address phone:** (318) 645-6161
- **Practice address fax:** (318) 798-4601
- **Mailing address:** PO BOX 5313, SHREVEPORT, LA 71135-5313
- **Mailing address phone:** (318) 645-6161
- **Mailing address fax:** (318) 798-4601

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 23409 | LA | Yes |

## Other

- **Enumeration date:** 09/14/2007
- **Last updated:** 08/23/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1494909 | — | LA |
| 01 | — | DG4348 | RAILROAD MEDICARE GROUP NUMBER | LA |