Healthcare Provider Details

I. General information

NPI: 1689125072
Provider Name (Legal Business Name): MINDEN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PLAZA PL
MINDEN LA
71055-3330
US

IV. Provider business mailing address

1 MEDICAL PLAZA PL
MINDEN LA
71055-3330
US

V. Phone/Fax

Practice location:
  • Phone: 318-371-5638
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13289
License Number StateLA

VIII. Authorized Official

Name: JOHN CRUMBLER
Title or Position: NURSE MANAGER
Credential:
Phone: 318-371-5634