Organization
OUR LADY OF THE LAKE PHYSICIAN GROUP LLC
Active
Other names
Pediatric Emergency Services
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY LIMBOCKER (CFO)
(225) 765-7727
Entity
Organization
Contact information
Practice address
7777 HENNESSY BLVD, STE 6002, BATON ROUGE, LA 70808-4300
(225) 765-7727
(225) 766-5645
Mailing address
7777 HENNESSY BLVD, STE 6002, BATON ROUGE, LA 70808-4300
(225) 765-7727
(225) 766-5645
Taxonomy
Speciality
Code
Description
License number
State
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
—
—
Other
Enumeration date
10/12/2011
Last updated
10/12/2011
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