Organization
OUR LADY OF THE LAKE HOSPITAL, INC
Active
Parent organization
OUR LADY OF THE LAKE HOSPITAL, INC
Other names
Pediatric Specialty Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
OUR LADY OF THE LAKE HOSPITAL, INC
Authorized official
JEFFERY D. LIMBOCKER JR. (CFO)
(225) 765-6306
Entity
Organization
Contact information
Practice address
5000 HENNESSY BLVD, BATON ROUGE, LA 70808-4375
(225) 765-7163
(225) 765-7164
Mailing address
8415 GOODWOOD BLVD, STE 105, BATON ROUGE, LA 70806-7851
(225) 765-5727
(225) 765-4278
Taxonomy
Speciality
Code
Description
License number
State
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08775372
—
MS
05
—
1447129
—
LA
Enumeration date
08/12/2009
Last updated
04/15/2011
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