Provider Demographics
NPI:1427496462
Name:SOUTH BEAUREGARD HEALTH CENTER, L.L.C.
Entity type:Organization
Organization Name:SOUTH BEAUREGARD HEALTH CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:KINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:337-462-7111
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-0490
Mailing Address - Country:US
Mailing Address - Phone:337-462-7106
Mailing Address - Fax:337-462-7479
Practice Address - Street 1:12186 HIGHWAY 171
Practice Address - Street 2:
Practice Address - City:LONGVILLE
Practice Address - State:LA
Practice Address - Zip Code:70652-4625
Practice Address - Country:US
Practice Address - Phone:337-462-7106
Practice Address - Fax:337-462-7479
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL SERVICE DISTRICT NO 2 OF PARISH OF BEAUREGARD STATE OF LA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care