Healthcare Provider Details

I. General information

NPI: 1053365759
Provider Name (Legal Business Name): OUR LADY OF THE LAKE HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 GOODWOOD BLVD STE 200
BATON ROUGE LA
70806-7851
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 225-765-8674
  • Fax: 225-765-4062
Mailing address:
  • Phone: 225-765-5727
  • Fax: 225-765-9244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

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