NPIMap

Organization Active NPI

Beauregard Family Medical Center, LLC

  • Multi-Specialty Clinic/Center
  • Deridder, LA
National Provider Identifier
1326387705
Registry record updated Nov 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 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
Last updated
Nov 25, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
WEST LOUISIANA HEALTH SERVICES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 25, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Darrell L Kingham, CPA
Title
Cfo
Phone
(337) 462-7409

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X
Multi-Specialty Clinic/Center 261QM1300X Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130413000098 LA Part B Supplier - Clinic/Group Practice 3577709708 Receives reassigned benefits from 17 practitioners
Practice locations: Deridder, LA

National Provider Directory

National Provider Directory
Part of
Beauregard Memorial Hos

Locations

501 S Pine St
#C
Deridder, LA 70634
Phone (337) 463-9890

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1360022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606262400000",
    "number": "1326387705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 730",
            "city": "DERIDDER",
            "state": "LA",
            "postal_code": "706340730",
            "telephone_number": "337-462-7409",
            "fax_number": "337-462-7479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S PINE ST",
            "city": "DERIDDER",
            "state": "LA",
            "postal_code": "706344939",
            "telephone_number": "337-462-7409",
            "fax_number": "337-462-7479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAUREGARD FAMILY MEDICAL CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WEST LOUISIANA HEALTH SERVICES, INC",
        "enumeration_date": "2013-02-05",
        "last_updated": "2020-11-25",
        "certification_date": "2020-11-25",
        "status": "A",
        "authorized_official_last_name": "KINGHAM",
        "authorized_official_first_name": "DARRELL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "337-462-7409",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Deridder, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.