Organization
BEAUREGARD MEDICAL GROUP LLC
Active
Other names
South Beauregard Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID VIZINAT APRN FNP-C (OWNER/ PROVIDER)
(337) 405-7778
Entity
Organization
Contact information
Practice address
12186 HIGHWAY 171, LONGVILLE, LA 70652
(337) 226-5301
Mailing address
12186 HIGHWAY 171, LONGVILLE, LA 70652-4625
(337) 405-7778
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
AP08501
LA
261QR1300X
Rural Health Clinic/Center
AP08501
LA
363LF0000X
Family Nurse Practitioner
AP08501
LA
Other
Enumeration date
10/26/2016
Last updated
02/04/2020
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