Healthcare Provider Details

I. General information

NPI: 1801087184
Provider Name (Legal Business Name): BEAUREGARD MEMORIAL HOSPITAL MEDICAL STAFF SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 06/07/2025
Certification Date: 06/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S PINE ST
DERIDDER LA
70634-4942
US

IV. Provider business mailing address

PO BOX 730
DERIDDER LA
70634-0730
US

V. Phone/Fax

Practice location:
  • Phone: 337-462-7100
  • Fax: 337-462-7435
Mailing address:
  • Phone: 337-462-7100
  • Fax: 337-462-7435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JARRED VEILLON
Title or Position: CFO
Credential:
Phone: 337-462-7409