MEDICARE: OUR LADY OF THE LAKE HOSPITAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant
2	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1831401488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUR LADY OF THE LAKE HOSPITAL INC

Provider Business Mailing Address
First Line	:	PO BOX 54227
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70154-4227
Country	:	US
Telephone Number	:	877-490-6544
Fax Number	:	605-275-4009

Provider Business Practice Location Address
First Line	:	307 3RD ST
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70801-1308
Country	:	US
Telephone Number	:	225-400-9921
Fax Number	:	225-400-9922

Authorized Official
Title or Position	:	COO
Name	:	MS. TERRIE P STERLING
Credential	:
Telephone Number	:	225-765-6898

Provider Enumeration Date	:	07/12/2010
Last Update Date	:	10/14/2010

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