Organization
OUR LADY OF THE LAKE PHYSICIAN GROUP, LLC
Active
Parent organization
OUR LADY OF THE LAKE PHYSICIAN GROUP, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
OUR LADY OF THE LAKE PHYSICIAN GROUP, LLC
Authorized official
MR. JEFFREY LIMBOCKER (CFO)
(225) 765-8551
Entity
Organization
Contact information
Practice address
5439 AIRLINE HWY, BATON ROUGE, LA 70805-1712
(225) 358-4853
(225) 358-2350
Mailing address
2051 SILVERSIDE DR, SUITE 260, BATON ROUGE, LA 70808-9005
(225) 490-8808
(225) 765-9687
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Enumeration date
12/15/2014
Last updated
12/15/2014
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