Beauregard Urology Center, LLC
Organization Active NPI Urology Physician · Deridder, LA
NPI 1891124384 · NPPES record last updated Nov 3, 2016
Key facts
- NPI
- 1891124384
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Urology Physician 208800000X
- Legal business name
- BEAUREGARD UROLOGY CENTER, LLC
- Practice address
- 316 W 7TH St
Deridder, LA 70634-4914 - Phone
- (337) 462-7409
- Fax
- (337) 462-7479
- NPI assigned
- Nov 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
Member of 1
Practitioners 6
-
Amanda Leigh Harrell, F.N.P.-C
-
Chuen K Kwok, M.D.
-
Christina Miller, FNP-C
-
Kellie Bourg Paddy, A.P.R.N.
-
Anita Thibodeaux, NP
-
Dennis W. Kleinpeter, APRN, ANP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 19D2073339 | Beauregard Urology Center, LLC | Certificate of waiver | Feb 16, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140409001629 | LA | Part B Supplier - Clinic/Group Practice | 6709018575 |
Receives reassigned benefits from 4 practitioners Practice locations: Deridder, LA |
National Provider Directory
- Part of
- Beauregard Memorial Hospital Medical Staff Services
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician |
208800000X | Yes |
Addresses
Primary practice location
316 W 7TH St
Deridder, LA 70634-4914
Mailing address
PO Box 730
Deridder, LA 70634-0730
Phone (337) 462-7409
Other names
- Chuen K. Kwok, M.D.
Other providers in Deridder, LA
- Beauregard Physical Therapy Clinic, Inc
- Beauregard Physician Group, LLC
- Beauregard Physician Services LLC
- Beauregard Surgery Center, LLC
- Beauregard Urgent Care Center, LLC
- Beauregard Women'S Health Center, LLC
- Kristen M Behar Allen
- Andraws Beibi
- Jessica Nicole Bell
- Kimber Bennett
All providers in Deridder, LA · Urology Physician 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 3, 2016. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.