Healthcare Provider Details

I. General information

NPI: 1427522929
Provider Name (Legal Business Name): BEAUREGARD MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 02/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 N. PINE STREET, STE B
DERIDDER LA
70634-2418
US

IV. Provider business mailing address

1512 N. PINE STREET, STE B
DERIDDER LA
70634-2418
US

V. Phone/Fax

Practice location:
  • Phone: 337-463-8850
  • Fax: 337-463-8850
Mailing address:
  • Phone: 337-463-8850
  • Fax: 337-463-8850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY GONZALEZ
Title or Position: COMPLIANCE OFFICE/MGR
Credential: COMPLIANCE OFFICER
Phone: 337-463-8850