Provider Demographics
NPI:1134385198
Name:BEQUILLARD & BEQUILLARD LLC
Entity type:Organization
Organization Name:BEQUILLARD & BEQUILLARD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:BEQUILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-749-1930
Mailing Address - Street 1:600 CUT OFF RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:PORT ARANSAS
Mailing Address - State:TX
Mailing Address - Zip Code:78373-4246
Mailing Address - Country:US
Mailing Address - Phone:361-749-1930
Mailing Address - Fax:361-749-1933
Practice Address - Street 1:600 CUT OFF RD STE 14
Practice Address - Street 2:
Practice Address - City:PORT ARANSAS
Practice Address - State:TX
Practice Address - Zip Code:78373-4246
Practice Address - Country:US
Practice Address - Phone:361-749-1930
Practice Address - Fax:361-749-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2024-05-08
Deactivation Date:2008-10-22
Deactivation Code:
Reactivation Date:2009-12-03
Provider Licenses
StateLicense IDTaxonomies
TX207P00000X261QP2300X
TXG8391207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1821670-01Medicaid
TX611774Medicare PIN
TX1821670-01Medicaid