Provider Demographics
NPI:1992005532
Name:BEAUREGARD PEDIATRIC CENTER, LLC
Entity Type:Organization
Organization Name:BEAUREGARD PEDIATRIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BADGER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:337-462-7105
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:337-462-7106
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:337-462-7106
Practice Address - Fax:337-462-7479
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST LOUISIANA HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty