Provider Demographics
NPI:1740847771
Name:OUR LADY OF THE LAKE HOSPITAL, INC.
Entity type:Organization
Organization Name:OUR LADY OF THE LAKE HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MARKET PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:SPICER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-765-7702
Mailing Address - Street 1:8300 CONSTANTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3489
Mailing Address - Country:US
Mailing Address - Phone:225-374-1350
Mailing Address - Fax:225-374-1351
Practice Address - Street 1:8300 CONSTANTIN BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3489
Practice Address - Country:US
Practice Address - Phone:225-374-1350
Practice Address - Fax:225-374-1351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-24
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy