Provider Demographics
NPI:1518205806
Name:BILLEDEAUX HEARING CENTER LLC
Entity Type:Organization
Organization Name:BILLEDEAUX HEARING CENTER LLC
Other - Org Name:MIRACLE EAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLEDEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-989-4327
Mailing Address - Street 1:4414 JOHNSTON ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-4253
Mailing Address - Country:US
Mailing Address - Phone:337-989-4327
Mailing Address - Fax:337-704-2240
Practice Address - Street 1:1625 E COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-1837
Practice Address - Country:US
Practice Address - Phone:337-989-4327
Practice Address - Fax:337-704-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSHA0578261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech