Healthcare Provider Details

I. General information

NPI: 1497986764
Provider Name (Legal Business Name): MINDEN PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PLAZA PL
MINDEN LA
71055-3330
US

IV. Provider business mailing address

346 HOMER RD
MINDEN LA
71055-2834
US

V. Phone/Fax

Practice location:
  • Phone: 318-377-2321
  • Fax:
Mailing address:
  • Phone: 318-226-8202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHANNON DAWN BROWN
Title or Position: DIRECTOR
Credential:
Phone: 318-382-7296