Provider Demographics
NPI:1316131808
Name:BILLEDEAUX HEARING CENTER, LLC
Entity type:Organization
Organization Name:BILLEDEAUX HEARING CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:BILLEDEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS,ACA
Authorized Official - Phone:337-989-4327
Mailing Address - Street 1:4414 JOHNSTON ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-4253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4414 JOHNSTON ST
Practice Address - Street 2:SUITE D
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-4253
Practice Address - Country:US
Practice Address - Phone:337-989-4327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1078261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CD37Medicare UPIN
LA4C468CD37Medicare PIN