Healthcare Provider Details

I. General information

NPI: 1972556348
Provider Name (Legal Business Name): OUR LADY OF THE LAKE HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9422 SCOTLAND AVE
BATON ROUGE LA
70807-3951
US

IV. Provider business mailing address

8415 GOODWOOD BLVD STE 105
BATON ROUGE LA
70806-7851
US

V. Phone/Fax

Practice location:
  • Phone: 225-774-1822
  • Fax: 225-774-1836
Mailing address:
  • Phone: 225-765-4226
  • Fax: 225-765-9244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TERRIE STERLING
Title or Position: COO
Credential:
Phone: 225-765-6898