Organization
OUR LADY OF THE LAKE PHYSICIAN GROUP LLC
Active
Parent organization
OUR LADY OF THE LAKE HOSPITAL INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
OUR LADY OF THE LAKE HOSPITAL INC
Authorized official
JAMY RICHARD (VP FINANCE)
(225) 490-8801
Entity
Organization
Contact information
Practice address
310 DUREL DR, NEW ROADS, LA 70760-2973
(225) 713-2400
(225) 713-2405
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(225) 526-0006
(225) 765-9291
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
AP07361
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447528
—
LA
Enumeration date
02/06/2007
Last updated
07/28/2016
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