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19D2082936 CLIA NUMBER - OUR LADY OF LAKE PHYSICIAN GROUP-MDVIP

Laboratory Demographics

CLIA Number: 19D2082936

Facility Name: OUR LADY OF LAKE PHYSICIAN GROUP-MDVIP

Facility Address:
17579 OLD JEFFERSON HIGHWAY
PRAIRIEVILLE, LA
ZIP 70769
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Facility Phone Number: 225 647-8511

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1144468422

Taxonomy: 208600000X - Surgery
A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

CLIA Record

Field Name Field Value
CLIA Number 19D2082936
LAB Type Physician Office
Facility Name OUR LADY OF LAKE PHYSICIAN GROUP-MDVIP
Street 17579 OLD JEFFERSON HIGHWAY
City PRAIRIEVILLE
State LA
ZIP 70769
Phone 225 647-8511
CertificateType 4
CertificateEffectiveDate 8/26/2022
CertificateExpirationDate 8/25/2024
FacilityType Waiver

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This page was last updated on: 4/23/2024