Healthcare Provider Details

I. General information

NPI: 1285890467
Provider Name (Legal Business Name): LAKEVIEW REGIONAL PHYSICIAN GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 LAKEVIEW CIRCLE
COVINGTON LA
70433-0001
US

IV. Provider business mailing address

PO BOX 405453
ATLANTA GA
30384-5453
US

V. Phone/Fax

Practice location:
  • Phone: 985-892-6858
  • Fax: 866-457-6080
Mailing address:
  • Phone: 615-373-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN REBOK
Title or Position: GROUP VICE PRESIDENT/AO
Credential:
Phone: 615-377-5004