OUR LADY OF THE LAKE PHYSICIAN GROUP LLC (NPI# 1912282831) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912282831 |
| Entity Type | Organization |
| Organization Name | OUR LADY OF THE LAKE PHYSICIAN GROUP LLC |
| Other Organization Name | PEDIATRIC EMERGENCY SERVICES |
| Practice Address |
7777 Hennessy Blvd Ste 6002 Baton Rouge LA 70808-4300 |
| Practice Telephone | 2257657727 |
| Practice Fax Number | 2257665645 |
| Mailing Telephone | 2257657727 |
| Mailing Fax Number | 2257665645 |
| Enumeration Date | 2011-10-12 |
| Last Update Date | 2011-10-12 |
| Authorized Official Name | JEFFREY LIMBOCKER (CFO) |
| Authorized Official Telephone | 2257657727 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0204X |
Pediatrics Specialization: Pediatric Emergency Medicine |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Pediatric Emergency Services | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518006568 | Our Lady of The Lake Physician Group LLC | Physician Assistant | 160 Hospital Rd, New Roads, LA 70760-2617 | 2007-02-06 |
| 1033494943 | Our Lady of The Lake Physician Group LLC | Allergy & Immunology | 7777 Hennessy Blvd, Ste 6002, Baton Rouge, LA 70808-4300 | 2011-10-12 |
| 1356643399 | Our Lady of The Lake Physician Group LLC | Internal Medicine | 8415 Goodwood Blvd, Ste 105, Baton Rouge, LA 70806-7851 | 2010-11-24 |
| 1447399308 | Our Lady of The Lake Physician Group LLC | Physician Assistant | 310 Durel Dr, New Roads, LA 70760-2973 | 2007-02-06 |
| 1356480214 | Our Lady of The Lake Physician Group LLC | Physician Assistant | 230 Roberts Dr, Suite B, New Roads, LA 70760-2661 | 2007-02-06 |
| 1174662035 | Our Lady of The Lake Physician Group LLC | Physician Assistant | 230 Roberts Dr, Suite H, New Roads, LA 70760-2661 | 2007-02-06 |
| 1184671455 | Our Lady of The Lake Physician Group LLC | Surgery | 4950 Essen Ln, Baton Rouge, LA 70809-3738 | 2006-05-30 |
| Street Address |
7777 HENNESSY BLVD STE 6002 |
| City | BATON ROUGE |
| State | LA |
| Zip Code | 70808-4300 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336143841 | Jeffrey Dean Hyde | Internal Medicine | 7777 Hennessy Blvd, Suite 1000, Baton Rouge, LA 70808-4300 | 2005-06-13 |
| 1487211397 | Karrie G Mccoy | Nurse Practitioner | 7777 Hennessy Blvd, Baton Rouge, LA 70808-4300 | 2019-05-27 |
| 1912466160 | Paige Cantrell Guillory | Student in an Organized Health Care Education/Training Program | 7777 Hennessy Blvd, Baton Rouge, LA 70808-4300 | 2019-03-18 |
| 1699267666 | Osaretin Charles Aimuyo | Pediatrics | 7777 Hennessy Blvd, Baton Rouge, LA 70808-4300 | 2018-06-05 |
| 1962992883 | John Ghassan | Student in an Organized Health Care Education/Training Program | 7777 Hennessy Blvd, Baton Rouge, LA 70808-4300 | 2018-05-16 |
| 1003312414 | Jamie Nicole Scharfschwerdt | Student in an Organized Health Care Education/Training Program | 7777 Hennessy Blvd, Baton Rouge, LA 70808-4300 | 2018-04-04 |
| 1356859888 | Kristen Pilcher Boudreaux | Nurse Anesthetist, Certified Registered | 7777 Hennessy Blvd, Ste 301, Baton Rouge, LA 70808 | 2018-01-18 |
| 1548784192 | Erickia Lee Le Meunier | Nurse Practitioner | 7777 Hennessy Blvd, Baton Rouge, LA 70808-4300 | 2017-07-26 |
| 1215457023 | Amy Miller | Nurse Practitioner | 7777 Hennessy Blvd, Baton Rouge, LA 70808-4300 | 2017-06-22 |
| 1053852806 | Kathryn Tetreault | Nurse Anesthetist, Certified Registered | 7777 Hennessy Blvd, Suite 301, Baton Rouge, LA 70808-4300 | 2017-03-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790313161 | Leah Michelle Dlugolecki | Student in an Organized Health Care Education/Training Program | Lsu Psychiatry Residency Program, 5246 Brittany Drive, Baton Rouge, LA 70808 | 2020-03-31 |
| 1003376302 | Kristina Pham | Student in an Organized Health Care Education/Training Program | 5246 Brittany Drive, 3rd Floor, Baton Rouge, LA 70808 | 2019-03-22 |
| 1083174486 | John Jay Hogan | Student in an Organized Health Care Education/Training Program | Lsu Emergency Medicine Residency Program, 5246 Brittany Drive, Baton Rouge, LA 70808 | 2019-03-21 |
| 1033682075 | Joseph Bertell Davis Jr. | Case Manager/Care Coordinator | 2460 College Drive, Baton Rouge, LA 70808 | 2019-01-02 |
| 1508340886 | Jennifer Miatech | Student in an Organized Health Care Education/Training Program | 8585 Picardy Ave., Medical Tower 2, Baton Rouge, LA 70808 | 2018-09-21 |
| 1700389137 | Jenee Robins | Case Manager/Care Coordinator | 2100 College Dr Apt 159, Baton Rouge, LA 70808 | 2018-03-12 |
| 1952812893 | Da Vonna Dents | Behavioral Analyst | 418 Stoney Creek Ave, Baton Rouge, LA 70808 | 2017-10-18 |
| 1962925669 | Katharine Elizabeth Blum | Counselor | 7936 Wrenwood Blvd. Ste A, Baton Rouge, LA 70808 | 2017-07-25 |
| 1801316120 | Amie Jackson | Social Worker | 5420 Corporate Blvd. Ste 308, Baton Rouge, LA 70808 | 2017-06-27 |
| 1235660713 | Melissa A Eddy-shelby | Student in an Organized Health Care Education/Training Program | 5000 Hennessy Blvs, Suite 6004, Baton Rouge, LA 70808 | 2017-03-25 |
| Find all providers in zip 70808 | ||||
| Taxonomy Code | 2080P0204X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Emergency Medicine |
| A pediatrician who has special qualifications to manage emergencies in infants and children. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881835866 | Hitesh Dhiraj Chheda | Pediatrics | 5000 Hennessy Blvd, Baton Rouge, LA 70808-4375 | 2009-03-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558723429 | Courtney Jacobs | Pediatrics | 864 S Clearview Pkwy, Apt 136, River Ridge, LA 70123-6323 | 2016-03-22 |
| 1518161736 | Ronald Anthony Hardey | Pediatrics | 201 Bent Tree Trl, Lafayette, LA 70508-7048 | 2007-06-12 |
| 1922080126 | Maria Stella Serrano | Pediatrics | 1315 Jefferson Highway, New Orleans, LA 70121 | 2005-11-15 |
| 1780003798 | Molly Sonenklar | Pediatrics | 200 Henry Clay Ave, New Orleans, LA 70118-5720 | 2014-04-08 |
| 1558618173 | Shamicka North | Pediatrics | 200 Henry Clay Ave, New Orleans, LA 70118-5798 | 2012-08-14 |
| 1316261316 | Emily Jo Harrison | Pediatrics | 200 Henry Clay Ave, New Orleans, LA 70118-5798 | 2010-03-19 |
| 1467602755 | Childrens Acute Care Inc | Pediatrics | 1 Saint Mary Pl, Box 40, Shreveport, LA 71101-4343 | 2008-09-24 |
| 1285825315 | Andrea Catherine Suen | Pediatrics | 200 Henry Clay Ave, New Orleans, LA 70118-5720 | 2007-08-05 |
| 1568663771 | Children's Hospital | Pediatrics | 200 Henry Clay Ave, New Orleans, LA 70118-5720 | 2007-05-29 |
| 1598837882 | Childrens Emergency Medicine Network of Louisiana | Pediatrics | 4600 Ambassador Caffery Pkwy, Lafayette, LA 70508-6902 | 2006-11-14 |
| Find all providers with the same taxonomy | ||||
| City | BATON ROUGE |
| Zip Code | 70808 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.