Amanda Lavigne Talbot, MD | |
4242 Highway 19 Ste C, Zachary, LA 70791-3981 | |
(225) 654-6140 | |
(225) 654-6122 |
Full Name | Amanda Lavigne Talbot |
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Gender | Female |
Speciality | Pediatrics |
Location | 4242 Highway 19 Ste C, Zachary, Louisiana |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1245448208 | NPI | - | NPPES |
1170771 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 202028 (Louisiana) | Primary |
Entity Name | Our Lady Of The Lake Physician Group Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1033494943 PECOS PAC ID: 4587849781 Enrollment ID: O20120529000377 |
Mailing Address | Practice Location Address |
---|---|
Amanda Lavigne Talbot, MD 5959 S Sherwood Forest Blvd, Baton Rouge, LA 70816-6038 Ph: (225) 765-5727 | Amanda Lavigne Talbot, MD 4242 Highway 19 Ste C, Zachary, LA 70791-3981 Ph: (225) 654-6140 |
Dr. Elenita P Santos-mata, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 4851 W Park Dr, Suite A, Zachary, LA 70791 Phone: 225-658-7636 Fax: 225-658-7634 | |
Amrullah Khelghati, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 9305 Main St, Suite D, Zachary, LA 70791 Phone: 225-654-0300 Fax: 225-654-0102 | |
Taira Lynn Woodroffe, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 4242 Highway 19, Building 3 Suite A, Zachary, LA 70791 Phone: 225-658-7860 Fax: 225-658-7862 |