Provider Demographics
NPI:1285916254
Name:MINDEN PHYSICIAN PRACTICES LLC
Entity type:Organization
Organization Name:MINDEN PHYSICIAN PRACTICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESS
Authorized Official - Middle Name:N
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-377-8855
Mailing Address - Street 1:PO BOX 1095
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71058-1095
Mailing Address - Country:US
Mailing Address - Phone:318-377-8855
Mailing Address - Fax:318-377-8852
Practice Address - Street 1:1 MEDICAL PLAZA PL
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-3330
Practice Address - Country:US
Practice Address - Phone:318-377-8855
Practice Address - Fax:318-377-8852
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINDEN PHYSICIAN PRACTICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-15
Last Update Date:2012-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2167197Medicaid
LA5DK44Medicare PIN