Provider Demographics
NPI:1821354218
Name:BILLEDEAUX HEARING CENTER LLC
Entity Type:Organization
Organization Name:BILLEDEAUX HEARING CENTER LLC
Other - Org Name:MIRACLE EAR OF LA
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:W
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
Mailing Address - Country:US
Mailing Address - Phone:337-989-4327
Mailing Address - Fax:337-704-2240
Practice Address - Street 1:3677 CALDER AVE
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-5027
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:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80185261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech