Provider Demographics
NPI:1316106628
Name:LAKE END SURGERY LLC
Entity type:Organization
Organization Name:LAKE END SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NWOSU
Authorized Official - Middle Name:O
Authorized Official - Last Name:NGOFA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-384-0897
Mailing Address - Street 1:PO BOX 1898
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70381-1898
Mailing Address - Country:US
Mailing Address - Phone:985-384-0897
Mailing Address - Fax:985-384-0899
Practice Address - Street 1:1300 LAKEWOOD DR
Practice Address - Street 2:SUITE A
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1866
Practice Address - Country:US
Practice Address - Phone:985-384-0897
Practice Address - Fax:985-384-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA201984208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty