Provider Demographics
NPI:1962720201
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:615-372-8500
Mailing Address - Street 1:101 MURRELL ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-3410
Mailing Address - Country:US
Mailing Address - Phone:318-371-1110
Mailing Address - Fax:318-371-1314
Practice Address - Street 1:101 MURRELL ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-3410
Practice Address - Country:US
Practice Address - Phone:318-371-1110
Practice Address - Fax:318-371-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty