Healthcare Provider Details

I. General information

NPI: 1316131808
Provider Name (Legal Business Name): BILLEDEAUX HEARING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 JOHNSTON ST SUITE D
LAFAYETTE LA
70503-4253
US

IV. Provider business mailing address

4414 JOHNSTON ST SUITE D
LAFAYETTE LA
70503-4253
US

V. Phone/Fax

Practice location:
  • Phone: 337-989-4327
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number1078
License Number StateLA

VIII. Authorized Official

Name: FREDERICK W BILLEDEAUX
Title or Position: OWNER/MANAGER
Credential: BC-HIS,ACA
Phone: 337-989-4327