Beauregard Family Medical Center, LLC
Organization Active NPI Multi-Specialty Clinic/Center · Deridder, LA
NPI 1326387705 · NPPES record last updated Nov 25, 2020
Key facts
- NPI
- 1326387705
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Multi-Specialty Clinic/Center 261QM1300X
- Legal business name
- BEAUREGARD FAMILY MEDICAL CENTER, LLC
- Practice address
- 501 S Pine St
Deridder, LA 70634-4939 - Phone
- (337) 462-7409
- Fax
- (337) 462-7479
- NPI assigned
- Feb 5, 2013
- Organization subpart
- Yes
- Parent organization (as reported)
- WEST LOUISIANA HEALTH SERVICES, INC
Authorized official
- Name
- Mr. Darrell L Kingham, CPA
- Title
- Cfo
- Phone
- (337) 462-7409
Practitioners 18
-
Fernando Garcia, M.D.
-
Christina Miller, FNP-C
-
Dallas Day, PMHNP-BC
-
Kati Dooley Day, APRN, CPNP-PC
-
Justin Nilsson Duke, M.D.
-
Amanda Leigh Harrell, F.N.P.-C
-
Dennis W. Kleinpeter, APRN, ANP
-
Rachel Anne Martin, CNM, WHNP
-
Kellie Bourg Paddy, A.P.R.N.
-
Flynn A Taylor I, M.D.
-
Arnette Scavella, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130413000098 | LA | Part B Supplier - Clinic/Group Practice | 3577709708 |
Receives reassigned benefits from 17 practitioners Practice locations: Deridder, LA |
National Provider Directory
- Part of
- Beauregard Memorial Hospital Medical Staff Services
Locations
501 S Pine St
#C
Deridder, LA 70634
Phone (337) 463-9890
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Service Clinic/Center | 261QH0100X | |||
| Multi-Specialty Clinic/Center | 261QM1300X | Yes |
Addresses
Primary practice location
501 S Pine St
Deridder, LA 70634-4939
Mailing address
PO Box 730
Deridder, LA 70634-0730
Phone (337) 462-7409
Other providers in Deridder, LA
- Beauregard Arc
- Beauregard Arc
- Beauregard Arc
- Beauregard Behavioral Health Clinic
- Beauregard Emergency Group LLC
- Beauregard Family Medicine LLC
- Beauregard Hematolog & Oncology
- Beauregard Hematology & Oncology
- Beauregard Internal Medicine Center, LLC
- Beauregard Medical and Surgical Center, LLC
All providers in Deridder, LA · Multi-Specialty Clinic/Center in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 25, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.