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OUR LADY OF THE LAKE REGIONAL MEDICA NPI 1972645216


NPI Information

NPI: 1972645216
Provider Name: OUR LADY OF THE LAKE REGIONAL MEDICA

Doing Business As: OUR LADY OF THE LAKE HOSPITAL INC PEDIATRIC PULMONARY CLINIC

Classification: Pediatrics - 2080P0214X
Entity Type: Organization

Specialization: Pediatric Pulmonology

CLIA Number: 19D2189683

Address:
7777 HENNESSY BLVD
PLAZA 1 SUITE 406
BATON ROUGE, LA
ZIP 70810
Phone: (225) 765-3456
Get Directions

OUR LADY OF THE LAKE REGIONAL MEDICA is a pediatric pulmonology pediatrics in Baton Rouge, LA. The provider is a pediatrician dedicated to the prevention and treatment of all respiratory diseases affecting infants, children and young adults. This specialist is knowledgeable about the growth and development of the lung, assessment of respiratory function in infants and children, and experienced in a variety of invasive and noninvasive diagnostic techniques. OUR LADY OF THE LAKE REGIONAL MEDICA NPI is 1972645216. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Our Lady Of The Lake Hospital Inc Pediatric Pulmonary Clinic.

The provider's business location address is:

7777 HENNESSY BLVD
PLAZA 1 SUITE 406
BATON ROUGE, LA
ZIP 70810
Phone: (225) 765-3456
Fax: (225) 765-1899

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) 765-4251.

The CLIA number assigned to this NPI record is 19D2189683 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/13/2007 and was last updated on 5/19/2011.


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
12080P0214XPediatricsPediatric PulmonologyYes

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
15H580MEDICARE ID-TYPE UNSPECIFIEDLOUISIANA
21445584MEDICAIDLOUISIANA

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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