Organization
LAKEVIEW REGIONAL PHYSICIAN GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN REBOK (GROUP VICE PRESIDENT/AO)
(615) 377-5004
Entity
Organization
Contact information
Practice address
130 LAKEVIEW CIRCLE, COVINGTON, LA 70433-0001
(985) 892-6858
(866) 457-6080
Mailing address
PO BOX 405453, ATLANTA, GA 30384-5453
(615) 373-7600
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00837785
—
MS
05
—
1384313
—
LA
Enumeration date
08/06/2008
Last updated
06/09/2022
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