Provider Demographics
NPI:1013013952
Name:MANAGEMENT SERVICES OF BEAUREGARD PARISH, INC.
Entity Type:Organization
Organization Name:MANAGEMENT SERVICES OF BEAUREGARD PARISH, INC.
Other - Org Name:MANAGEMENT SERVICES OF BEAUREGARD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:H
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-590-0007
Mailing Address - Street 1:965 FISHER RD
Mailing Address - Street 2:
Mailing Address - City:MANY
Mailing Address - State:LA
Mailing Address - Zip Code:71449-3819
Mailing Address - Country:US
Mailing Address - Phone:318-590-0007
Mailing Address - Fax:318-590-1711
Practice Address - Street 1:965 FISHER RD
Practice Address - Street 2:
Practice Address - City:MANY
Practice Address - State:LA
Practice Address - Zip Code:71449-3819
Practice Address - Country:US
Practice Address - Phone:318-590-0007
Practice Address - Fax:318-590-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1961124Medicaid
LA0289420001Medicare NSC