Provider Demographics
NPI:1881015345
Name:BEAUREGARD HEMATOLOGY & ONCOLOGY
Entity Type:Organization
Organization Name:BEAUREGARD HEMATOLOGY & ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:G
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-463-4777
Mailing Address - Street 1:301 S WASHINGTON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-4861
Mailing Address - Country:US
Mailing Address - Phone:337-463-7444
Mailing Address - Fax:337-463-4770
Practice Address - Street 1:301 S WASHINGTON ST
Practice Address - Street 2:SUITE B
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-4861
Practice Address - Country:US
Practice Address - Phone:337-463-7444
Practice Address - Fax:337-463-4770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD206603174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty