Provider Demographics
NPI:1821419334
Name:BEAUREGARD HEMATOLOG & ONCOLOGY
Entity Type:Organization
Organization Name:BEAUREGARD HEMATOLOG & ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:G
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:PRACTICE MANAGER
Authorized Official - Phone:337-463-4777
Mailing Address - Street 1:301 S. WASHINGTON ST.
Mailing Address - Street 2:STE B
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634
Mailing Address - Country:US
Mailing Address - Phone:337-463-4777
Mailing Address - Fax:337-463-4770
Practice Address - Street 1:301 S. WASHINGTON ST.
Practice Address - Street 2:STE B
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634
Practice Address - Country:US
Practice Address - Phone:337-463-4777
Practice Address - Fax:337-463-4770
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEAUREGARD HEMATOLOGY & ONCOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-31
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD206603207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty