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OUR LADY OF THE LAKE PHYSICIAN GROUP LLC NPI 1184671455


NPI Information

NPI: 1184671455
Provider Name: OUR LADY OF THE LAKE PHYSICIAN GROUP LLC

Doing Business As: OLOL PHYSICIAN SURGICAL SPECIALTY

Classification: Internal Medicine - 207RH0003X
Entity Type: Organization

Specialization: Hematology & Oncology

CLIA Number: 19D2127892

Address:
4950 ESSEN LN
BATON ROUGE, LA
ZIP 70809
Phone: (225) 767-1311
Get Directions

OUR LADY OF THE LAKE PHYSICIAN GROUP LLC is a hematology and oncology internal medicine in Baton Rouge, LA. The provider is an internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. OUR LADY OF THE LAKE PHYSICIAN GROUP LLC NPI is 1184671455. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Olol Physician Surgical Specialty.

The provider's business location address is:

4950 ESSEN LN
BATON ROUGE, LA
ZIP 70809-738
Phone: (225) 767-1311
Fax: (225) 767-1335

The provider's authorized official is Tamara White .
The authorized official title is Director Of Business Services and has the following contact phone number (225) 765-5727.

The CLIA number assigned to this NPI record is 19D2127892 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/30/2006 and was last updated on 2/20/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207RH0003XInternal MedicineHematology & OncologyYes
2208600000XSurgeryNo
32086S0127XSurgeryTrauma SurgeryNo
4208C00000XColon & Rectal SurgeryNo
5363A00000XPhysician AssistantNo
6363L00000XNurse PractitionerNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11447218MEDICAIDLOUISIANA
25CR65MEDICARE PINLOUISIANA
305684711MEDICAIDMISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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