| Our Lady Of The Lake Hospital Inc | |
|
8415 Goodwood Blvd Ste 200 Baton Rouge LA 70806-7851 | |
| (225) 765-8674 | |
| (225) 765-4062 |
| Full Name | Our Lady Of The Lake Hospital Inc |
|---|---|
| Speciality | Pediatrics |
| Location | 8415 Goodwood Blvd, Baton Rouge, Louisiana |
| Authorized Official Name and Position | Terrie P Sterling (COO) |
| Authorized Official Contact | 2257656898 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Our Lady Of The Lake Hospital Inc 8415 Goodwood Blvd Ste 105 Baton Rouge LA 70806-7851 Ph: (225) 765-5727 | Our Lady Of The Lake Hospital Inc 8415 Goodwood Blvd Ste 200 Baton Rouge LA 70806-7851 Ph: (225) 765-8674 |
| NPI Number | 1053365759 |
|---|---|
| Provider Enumeration Date | 05/19/2006 |
| Last Update Date | 04/15/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053365759 | NPI | - | NPPES |
| 1113069 | Medicaid | LA | |
| 06828887 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Secondary |
| 208000000X | Pediatrics | (* (Not Available)) | Primary |
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