| Our Lady Of The Lake Physician Group-riverside | |
|
18740 Highway 22 Maurepas LA 70449-3018 | |
| (225) 698-3435 | |
| (225) 698-6446 |
| Full Name | Our Lady Of The Lake Physician Group-riverside |
|---|---|
| Speciality | Clinic/Center |
| Location | 18740 Highway 22, Maurepas, Louisiana |
| Authorized Official Name and Position | Jamy A Richard (VP FINANCE) |
| Authorized Official Contact | 2255260121 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Our Lady Of The Lake Physician Group-riverside 18740 Highway 22 Maurepas LA 70449-3018 Ph: (225) 698-3435 | Our Lady Of The Lake Physician Group-riverside 18740 Highway 22 Maurepas LA 70449-3018 Ph: (225) 698-3435 |
| NPI Number | 1134152630 |
|---|---|
| Provider Enumeration Date | 07/08/2006 |
| Last Update Date | 03/01/2017 |
| Medicare PECOS PAC ID | 4587849781 |
|---|---|
| Medicare Enrollment ID | O20161220000447 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134152630 | NPI | - | NPPES |
| 1408239 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | 115 (Louisiana) | Primary |
Pediatric Group Of Acadiana, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 12713 Water Way, Maurepas, LA 70449 Phone: 225-698-0211 |