Provider Demographics
NPI:1164419198
Name:OUR LADY OF THE LAKE HOSPITAL, INC.
Entity Type:Organization
Organization Name:OUR LADY OF THE LAKE HOSPITAL, INC.
Other - Org Name:OUR LADY OF THE LAKE REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:K
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-765-7702
Mailing Address - Street 1:5000 HENNESSY BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4375
Mailing Address - Country:US
Mailing Address - Phone:225-765-7702
Mailing Address - Fax:
Practice Address - Street 1:5000 HENNESSY BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4375
Practice Address - Country:US
Practice Address - Phone:225-765-6565
Practice Address - Fax:225-767-1159
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUR LADY OF THE LAKE HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-04
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19-S064Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER