OUR LADY OF THE LAKE PHYSICIAN GROUP, LLC (NPI# 1588062079) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588062079 |
| Entity Type | Organization |
| Organization Name | OUR LADY OF THE LAKE PHYSICIAN GROUP, LLC |
| Practice Address |
5439 Airline Hwy Baton Rouge LA 70805-1712 |
| Mailing Address |
2051 Silverside Dr Suite 260 Baton Rouge LA 70808-9005 |
| Practice Telephone | 2253584853 |
| Practice Fax Number | 2253582350 |
| Mailing Telephone | 2254908808 |
| Mailing Fax Number | 2257659687 |
| Enumeration Date | 2014-12-15 |
| Last Update Date | 2014-12-15 |
| Authorized Official Name | MR. JEFFREY LIMBOCKER (CFO) |
| Authorized Official Telephone | 2257658551 |
| Is Organization Subpart | Y |
| Parent Organization Name | OUR LADY OF THE LAKE PHYSICIAN GROUP, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QU0200X |
Clinic/Center Specialization: Urgent Care |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134152630 | Our Lady of The Lake Physician Group, LLC | Clinic/Center | 18740 Highway 22, Maurepas, LA 70449-3018 | 2006-07-08 |
| 1972052520 | Our Lady of The Lake Physician Group, LLC | Clinic/Center | 1401 N Foster Dr, Baton Rouge, LA 70806-1818 | 2016-09-23 |
| Street Address |
5439 AIRLINE HWY |
| City | BATON ROUGE |
| State | LA |
| Zip Code | 70805-1712 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194782839 | Laura Catherine Richey | Emergency Medicine | 5439 Airline Hwy, Baton Rouge, LA 70805-1712 | 2006-04-27 |
| 1245714955 | Lounida Johnson | Nurse Practitioner | 5439 Airline Hwy, Baton Rouge, LA 70805 | 2018-09-18 |
| 1245725837 | Nicholas Ryan Boone | Nurse Practitioner | 5439 Airline Hwy, Baton Rouge, LA 70805-1712 | 2018-06-26 |
| 1760868624 | Julie D Guillet | Physician Assistant | 5439 Airline Hwy, Baton Rouge, LA 70805-1712 | 2015-08-03 |
| 1134540115 | Convenient Care LLC | Clinic/Center | 5439 Airline Hwy, Baton Rouge, LA 70805-1712 | 2013-12-18 |
| 1730519356 | Angelia Diane Honora | Nurse Practitioner | 5439 Airline Hwy, Baton Rouge, LA 70805-1712 | 2013-11-18 |
| 1326474990 | Elizabeth Ann Loretta Valure | Physician Assistant | 5439 Airline Hwy, Baton Rouge, LA 70805-1712 | 2013-09-16 |
| 1538593538 | Keytha Lubirta Thompson | Nurse Practitioner | 5439 Airline Hwy, Baton Rouge, LA 70805-1712 | 2013-08-26 |
| 1740526011 | Simone Olivier Stewart | Nurse Practitioner | 5439 Airline Hwy, Baton Rouge, LA 70805-1712 | 2012-12-14 |
| 1669724464 | Rebecca Arceneaux Landry | Physician Assistant | 5439 Airline Hwy, Baton Rouge, LA 70805-1712 | 2012-10-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306481445 | Upgrade Group Home LLC | Residential Treatment Facility, Emotionally Disturbed Children | 3719 Katherine Ave, 3719 Katherine Ave, Baton Rouge, LA 70805 | 2019-11-13 |
| 1164991899 | Hip Hop Barbers, LLC | Specialist | 5709 Hollywood Crossover St, Baton Rouge, LA 70805 | 2018-11-26 |
| 1093234783 | Omar Feme Braggs I | Counselor | 3973 Choctaw Drive, Baton Rouge, LA 70805 | 2017-09-13 |
| 1558883116 | Jeffrey Williams | Counselor | 3456 Eaton Street, Baton Rouge, LA 70805 | 2017-07-14 |
| 1215466628 | Angel Danielle Morgan | Counselor | 3540 Ontario St., Baton Rouge, LA 70805 | 2017-06-08 |
| 1376904151 | Mama's Medical Transportation | Non-emergency Medical Transport (VAN) | 2727 North Ardenwood Dr., Baton Rouge, LA 70805 | 2016-03-08 |
| 1013389105 | Tiffany Thomas | Counselor | 8325 Kelwood Avenue, Baton Rouge, LA 70805 | 2015-10-28 |
| 1366823395 | Travia Linette Washington | Community Health Worker | 2959 Sherwood St, Baton Rouge, LA 70805 | 2015-06-16 |
| 1295000164 | Capital Area Human Services District | Substance Abuse Rehabilitation Facility | 2455 Wooddale Blvd., Baton Rouge, LA 70805 | 2012-03-12 |
| 1427332238 | Carl P Thibodeaux | Pharmacist | 5889 Airline Highway, Baton Rouge, LA 70805 | 2011-09-29 |
| Find all providers in zip 70805 | ||||
| Taxonomy Code | 261QU0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Urgent Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568002442 | Sara Miller | Clinic/Center | 9602 Myrtle Ln, Baton Rouge, LA 70810-4238 | 2020-01-08 |
| 1831463470 | Beaumont Urgent Care Clinic | Clinic/Center | 2097 Beaumont Dr, Baton Rouge, LA 70806-1412 | 2012-02-29 |
| 1518250356 | Convenient Care LLC | Clinic/Center | 13686 Coursey Blvd, Baton Rouge, LA 70817-1303 | 2011-05-26 |
| 1831496793 | Baton Rouge Clinic, A Medical Corporation | Clinic/Center | 7479 Perkins Rd, Baton Rouge, LA 70808-4328 | 2011-02-11 |
| 1649596321 | Fast Lane of Central LLC | Clinic/Center | 11421 Sullivan Rd, Bldg B, Baton Rouge, LA 70818 | 2010-04-20 |
| 1295986438 | Convenient Care LLC | Clinic/Center | 123 Lee Drive, Baton Rouge, LA 70808 | 2008-10-07 |
| 1821181801 | Convenient Care LLC | Clinic/Center | 2380 Oneal Ln, Suite A, Baton Rouge, LA 70816-9315 | 2006-10-02 |
| 1497848477 | Convenient Care LLC | Clinic/Center | 8751 Sullivan Road, Baton Rouge, LA 70818-0000 | 2006-10-02 |
| 1356974281 | Ut East Texas Urgent Care Centers | Clinic/Center | 10319 Jefferson Hwy, Baton Rouge, LA 70809-2730 | 2020-02-19 |
| 1972052520 | Our Lady of The Lake Physician Group, LLC | Clinic/Center | 1401 N Foster Dr, Baton Rouge, LA 70806-1818 | 2016-09-23 |
| Find all providers in BATON ROUGE | ||||
| City | BATON ROUGE |
| Zip Code | 70805 |
Please comment or provide details below to improve the information on OUR LADY OF THE LAKE PHYSICIAN GROUP, LLC.
| 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.