Organization
OUR LADY OF THE LAKE PHYSICIAN GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY D LIMBOCKER (REGIONAL CFO)
(225) 765-8550
Entity
Organization
Contact information
Practice address
1401 N FOSTER DR, BATON ROUGE, LA 70806-1818
(225) 987-9095
(225) 987-9096
Mailing address
5000 HENNESSY BLVD, BATON ROUGE, LA 70808-4375
(225) 765-4281
(225) 765-5645
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Enumeration date
09/23/2016
Last updated
09/23/2016
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