Provider Demographics
NPI:1427522929
Name:BEAUREGARD MEDICAL SUPPLY
Entity type:Organization
Organization Name:BEAUREGARD MEDICAL SUPPLY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICE/MGR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:COMPLIANCE OFFICER
Authorized Official - Phone:337-463-8850
Mailing Address - Street 1:1512 N. PINE STREET, STE B
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-2418
Mailing Address - Country:US
Mailing Address - Phone:337-463-8850
Mailing Address - Fax:337-463-8850
Practice Address - Street 1:1512 N. PINE STREET, STE B
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-2418
Practice Address - Country:US
Practice Address - Phone:337-463-8850
Practice Address - Fax:337-463-8850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-17
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2189867Medicaid