Provider Demographics
NPI:1043316631
Name:BPH ENTERPRISES, LLC
Entity type:Organization
Organization Name:BPH ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-749-2645
Mailing Address - Street 1:402 N VAUGHAN ST
Mailing Address - Street 2:
Mailing Address - City:BRUSLY
Mailing Address - State:LA
Mailing Address - Zip Code:70719-2225
Mailing Address - Country:US
Mailing Address - Phone:225-749-2645
Mailing Address - Fax:225-749-8216
Practice Address - Street 1:402 N VAUGHAN ST
Practice Address - Street 2:
Practice Address - City:BRUSLY
Practice Address - State:LA
Practice Address - Zip Code:70719-2225
Practice Address - Country:US
Practice Address - Phone:225-749-2645
Practice Address - Fax:225-749-8216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024237207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1446777Medicaid
LA5CK72Medicare ID - Type UnspecifiedMEDICARE GROUP
LA1446777Medicaid