Provider Demographics
NPI:1891750907
Name:HOSPITAL SERVICE DISTRICT NO 2 OF PARISH OF BEAUREGARD STATE OF LA
Entity Type:Organization
Organization Name:HOSPITAL SERVICE DISTRICT NO 2 OF PARISH OF BEAUREGARD STATE OF LA
Other - Org Name:BEAUREGARD MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:KINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:337-462-7111
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-0730
Mailing Address - Country:US
Mailing Address - Phone:337-462-7409
Mailing Address - Fax:337-462-7479
Practice Address - Street 1:600 S PINE ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-4942
Practice Address - Country:US
Practice Address - Phone:337-462-7409
Practice Address - Fax:337-462-7479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19U050OtherSWING BED
19U050Medicare UPIN