Healthcare Provider Details

I. General information

NPI: 1346676301
Provider Name (Legal Business Name): BEAUREGARD URGENT CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 5TH ST
DERIDDER LA
70634-4856
US

IV. Provider business mailing address

PO BOX 790 200W 5TH STREET
DERIDDER LA
70634-0790
US

V. Phone/Fax

Practice location:
  • Phone: 337-462-7106
  • Fax: 337-462-7479
Mailing address:
  • Phone: 337-462-7106
  • Fax: 337-462-7479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DARRELL L KINGHAM
Title or Position: CFO
Credential: CPA
Phone: 337-462-7111