Organization
OUR LADY OF THE LAKE HOSPITAL INC
Active
Parent organization
OUR LADY OF THE LAKE HOSPITAL INC
Other names
Lake Primary Care Physicians
Organization subpart
Yes
Provider details
NPI number
Legal business name
OUR LADY OF THE LAKE HOSPITAL INC
Authorized official
MS. JAMY RICHARD (DIR OF REIMBURSEMENT AND FINANCE)
(225) 765-4281
Entity
Organization
Contact information
Practice address
8415 GOODWOOD BLVD, SUITE 105, BATON ROUGE, LA 70806-7851
(225) 765-5727
(225) 765-9244
Mailing address
8415 GOODWOOD BLVD, SUITE 105, BATON ROUGE, LA 70806-7851
(225) 765-5727
(225) 765-9244
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1941913
—
LA
01
—
CD9919
RAILROAD MEDICARE (GROUP)
LA
Enumeration date
06/15/2006
Last updated
04/15/2011
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