| Our Lady Of The Lake Physician Group Llc | |
|
230 Roberts Dr Suite B New Roads LA 70760-2661 | |
| (225) 638-8661 | |
| (225) 638-2977 |
| Full Name | Our Lady Of The Lake Physician Group Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 230 Roberts Dr, New Roads, Louisiana |
| Authorized Official Name and Position | Elona Sharbaugh (VP PHYSICIAN PRACTICES) |
| Authorized Official Contact | 2254908806 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Our Lady Of The Lake Physician Group Llc 2051 Silverside Dr Suite 120 Baton Rouge LA 70808-9005 Ph: (225) 765-4226 | Our Lady Of The Lake Physician Group Llc 230 Roberts Dr Suite B New Roads LA 70760-2661 Ph: (225) 638-8661 |
| NPI Number | 1356480214 |
|---|---|
| Provider Enumeration Date | 02/06/2007 |
| Last Update Date | 12/10/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356480214 | NPI | - | NPPES |
| 1447510 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363A00000X | Physician Assistant | (* (Not Available)) | Secondary |
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