| Amanda Lavigne Talbot, MD | |
|
4242 Highway 19 Ste C, Zachary, LA 70791-3981 | |
| (225) 654-6140 | |
| (225) 654-6122 |
| Full Name | Amanda Lavigne Talbot |
|---|---|
| Gender | Female |
| Speciality | Pediatrics |
| Location | 4242 Highway 19 Ste C, Zachary, Louisiana |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245448208 | NPI | - | NPPES |
| 1170771 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | 202028 (Louisiana) | Primary |
| Entity Name | Our Lady Of The Lake Physician Group Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1033494943 PECOS PAC ID: 4587849781 Enrollment ID: O20120529000377 |
| Mailing Address | Practice Location Address |
|---|---|
| Amanda Lavigne Talbot, MD 5959 S Sherwood Forest Blvd, Baton Rouge, LA 70816-6038 Ph: (225) 765-5727 | Amanda Lavigne Talbot, MD 4242 Highway 19 Ste C, Zachary, LA 70791-3981 Ph: (225) 654-6140 |
Dr. Elenita P Santos-mata, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 4851 W Park Dr, Suite A, Zachary, LA 70791 Phone: 225-658-7636 Fax: 225-658-7634 | |
Amrullah Khelghati, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 9305 Main St, Suite D, Zachary, LA 70791 Phone: 225-654-0300 Fax: 225-654-0102 | |
Taira Lynn Woodroffe, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 4242 Highway 19, Building 3 Suite A, Zachary, LA 70791 Phone: 225-658-7860 Fax: 225-658-7862 |