Healthcare Provider Details

I. General information

NPI: 1518205806
Provider Name (Legal Business Name): BILLEDEAUX HEARING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 E COUNTY LINE RD
JACKSON MS
39211-1837
US

IV. Provider business mailing address

4414 JOHNSTON ST
LAFAYETTE LA
70503-4253
US

V. Phone/Fax

Practice location:
  • Phone: 337-989-4327
  • Fax: 337-704-2240
Mailing address:
  • Phone: 337-989-4327
  • Fax: 337-704-2240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberHA0578
License Number StateMS

VIII. Authorized Official

Name: MR. FREDERICK BILLEDEAUX
Title or Position: OWNER/ MANAGER
Credential:
Phone: 337-989-4327