OUR LADY OF THE LAKE PHYSICIAN GROUP, LLC (NPI# 1134152630) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134152630 |
| Entity Type | Organization |
| Organization Name | OUR LADY OF THE LAKE PHYSICIAN GROUP, LLC |
| Other Organization Name | OUR LADY OF THE LAKE PHYSICIAN GROUP-RIVERSIDE |
| Practice Address |
18740 Highway 22 Maurepas LA 70449-3018 |
| Practice Telephone | 2256983435 |
| Practice Fax Number | 2256986446 |
| Mailing Telephone | 2256983435 |
| Mailing Fax Number | 2256986446 |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2017-03-01 |
| Authorized Official Name | JAMY A RICHARD (VP FINANCE) |
| Authorized Official Telephone | 2255260121 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities | ||
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
115 | LA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1408239 | 05 |
| Other Name | Type Code |
|---|---|
| Our Lady of the Lake Physician Group-Riverside | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972052520 | Our Lady of The Lake Physician Group, LLC | Clinic/Center | 1401 N Foster Dr, Baton Rouge, LA 70806-1818 | 2016-09-23 |
| 1588062079 | Our Lady of The Lake Physician Group, LLC | Clinic/Center | 5439 Airline Hwy, Baton Rouge, LA 70805-1712 | 2014-12-15 |
| Street Address |
18740 HIGHWAY 22 |
| City | MAUREPAS |
| State | LA |
| Zip Code | 70449-3018 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700261294 | Timothy Joel Stern | Nurse Practitioner | 18740 Highway 22, Maurepas, LA 70449 | 2015-07-25 |
| 1356755565 | Trina M Keller | Nurse Practitioner | 18740 Highway 22, Maurepas, LA 70449-3018 | 2014-06-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588138903 | Pediatric Group of Acadiana, LLC | Clinic/Center | 12713 Water Way, Maurepas, LA 70449-1200 | 2019-01-18 |
| 1740437037 | Chris Pharmacy and Gifts LLC | Pharmacy | 18525 Highway 22, Maurepas, LA 70449-3015 | 2008-08-19 |
| 1255985347 | Trent Gordon | Pharmacist | 18525 Highway 22, Maurepas, LA 70449-3015 | 2019-07-28 |
| 1548768906 | Chelsea Rogers Miguez | Pharmacist | 18525 Highway 22, Maurepas, LA 70449-3015 | 2018-01-31 |
| 1740788256 | Cody Guitreau | Pharmacy | 18525 Highway 22, Maurepas, LA 70449-3015 | 2018-01-30 |
| 1437657046 | Marie Landry | Pharmacist | 18525 Highway 22, Maurepas, LA 70449-3015 | 2018-01-29 |
| 1710927330 | Linx Physical Therapy & Wellness | Physical Therapist | 12505 Homeport Dr, Suite A, Maurepas, LA 70449-3045 | 2006-06-08 |
| 1093757775 | Marcy L Linxwiler | Physical Therapist | 12505 Homeport Dr, Suite A, Maurepas, LA 70449-3045 | 2006-06-10 |
| 1265527808 | Melody Hammons Harper | Physical Therapist | 18780 Highway 22 Ste E, Maurepas, LA 70449-3054 | 2006-10-03 |
| 1023208675 | Broderick Letrey Pinkney | Psychiatry & Neurology | 2810 East Causeway Approach, Mandeville, LA 70449-3502 | 2007-07-30 |
| Find all providers in zip 70449 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588138903 | Pediatric Group of Acadiana, LLC | Clinic/Center | 12713 Water Way, Maurepas, LA 70449-1200 | 2019-01-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356942155 | Clhg-ville Platte LLC | Clinic/Center | 804 E. Main Street, Ville Platte, LA 70586 | 2020-11-06 |
| 1568062446 | Lhcg Clxix, LLC | Clinic/Center | 821 N Union St, Opelousas, LA 70570-6313 | 2020-10-29 |
| 1760089791 | Blanchard Medical | Clinic/Center | 5948 N Market St, Shreveport, LA 71107-2017 | 2020-10-02 |
| 1922619238 | Pediatric Group of Acadiana, LLC | Clinic/Center | 818 W. Veterans Memorial, Kaplan, LA 70548 | 2020-08-11 |
| 1720606478 | Dr Lawanda Lamar Bellamy Md A Professional Medical Corporation | Clinic/Center | 1307 Crowley-rayne Hwy, Suite B, Crowley, LA 70526 | 2020-07-09 |
| 1669002002 | Franklin Parish Hospital Service Dist 1 | Clinic/Center | 7645 Gilbert Street, Gilbert, LA 71336 | 2020-01-24 |
| 1184260937 | Children's International, LLC | Clinic/Center | 5151 Plank Rd Ste 190, Baton Rouge, LA 70805-3501 | 2019-11-26 |
| 1003467440 | Clhg-acadian LLC | Clinic/Center | 151 Hill St Ste 102, Eunice, LA 70535-5845 | 2019-09-26 |
| 1164073524 | Tangi Wellness & Health | Clinic/Center | 906 C M Fagan Dr Ste B3, Hammond, LA 70403-6056 | 2019-09-26 |
| 1679126510 | Pediatric Group of Acadiana, LLC | Clinic/Center | 1307 Crowley Rayne Hwy Ste C, Crowley, LA 70526-8210 | 2019-07-19 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.