Organization
LAKE OLIVER EMERGENCY GROUP, LLC
Active
Other names
Capital Regional Medical Center Gadsden ER
Organization subpart
No
Provider details
NPI number
Authorized official
LISHA C FALK (VP OF CONTRACTING)
(337) 609-1221
Entity
Organization
Contact information
Practice address
23186 BLUE STAR HWY, QUINCY, FL 32351-5173
(850) 875-6000
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(337) 609-1153
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
01/06/2022
Last updated
09/27/2022
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