Our Lady of the Lake Plastic Clinic
Organization Active NPI Plastic Surgery Physician · Baton Rouge, LA
NPI 1639360704 · NPPES record last updated May 19, 2011
Key facts
- NPI
- 1639360704
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Plastic Surgery Physician 208200000X
- Legal business name
- OUR LADY OF THE LAKE PLASTIC CLINIC
- Practice address
- 7777 Hennessy Blvd
Suite 709
Baton Rouge, LA 70808-4300 - Phone
- (225) 765-7731
- NPI assigned
- Aug 5, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- OUR LADY OF THE LAKE HOSPITAL, INC.
Authorized official
- Name
- Mr. Tamara D White Jr.
- Title
- Director of Business Services
- Phone
- (225) 765-4251
Member of 2
Practitioners 5
-
James Anthony Stephens, M.D., F.A.C.S.
-
Taylor Bryan Theunissen, M.D.
-
Sarah L Young, PA-C
National Provider Directory
- Part of
- Industrial Family Medic
Locations
4950 Essen Ln
Ste C
Baton Rouge, LA 70809
Phone (225) 765-1982
7777 Hennessy Blvd
Ste 708
Baton Rouge, LA 70808
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician |
208200000X | Yes |
Addresses
Primary practice location
7777 Hennessy Blvd
Suite 709
Baton Rouge, LA 70808-4300
Mailing address
7777 Hennessy Blvd
Suite 709
Baton Rouge, LA 70808-4300
Phone (225) 765-7731
Other names
- Our Lady of the Lake Regional Medical Center
NPI Registry JSON
{
"created_epoch": "1186272000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1305763200000",
"number": "1639360704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7777 HENNESSY BLVD",
"address_2": "SUITE 709",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708084300",
"telephone_number": "225-765-7731"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7777 HENNESSY BLVD",
"address_2": "SUITE 709",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708084300",
"telephone_number": "225-765-7731"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OUR LADY OF THE LAKE PLASTIC CLINIC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "OUR LADY OF THE LAKE HOSPITAL, INC.",
"enumeration_date": "2007-08-05",
"last_updated": "2011-05-19",
"status": "A",
"authorized_official_last_name": "WHITE",
"authorized_official_first_name": "TAMARA",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "DIRECTOR OF BUSINESS SERVICES",
"authorized_official_telephone_number": "225-765-4251",
"authorized_official_name_prefix": "Mr.",
"authorized_official_name_suffix": "Jr."
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Plastic Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Our Lady of the Lake Regional Medical Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Baton Rouge, LA
- Our Lady of the Lake Physician Group LLC
- Our Lady of the Lake Physician Group LLC
- Our Lady of the Lake Physician Group LLC
- Our Lady of the Lake Physician Group, LLC
- Our Lady of the Lake Physician Group, LLC
- Our Lady of the Lake Regional Medica
- Our Lady of the Lake Regional Medical Center
- Our Lake of the Lake Head and Neck Ce
- Our Lake of the Lake Hospital Inc
- David Michael Ourso
All providers in Baton Rouge, LA · Plastic Surgery Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.