# OUR LADY OF THE LAKE REGIONAL MEDICA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Our Lady Of The Lake Hospital Inc Pediatric Pulmonary Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972645216
- **Authorized official:** TAMARA WHITE (DIRECTOR OF BUSINESS SERVICES)
- **Authorized official phone:** (225) 765-4251

## Contact information

- **Practice address:** 7777 HENNESSY BLVD, PLAZA 1 SUITE 406, BATON ROUGE, LA 70810
- **Practice address phone:** (225) 765-3456
- **Practice address fax:** (225) 765-1899
- **Mailing address:** 8415 GOODWOOD BLVD, SUITE 105, BATON ROUGE, LA 70806
- **Mailing address phone:** (225) 413-4361
- **Mailing address fax:** (225) 765-4062

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080P0214X | Pediatric Pulmonology Physician | — | NULL | Yes |
| 2080P0214X | Pediatric Pulmonology Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/13/2007
- **Last updated:** 05/19/2011