Healthcare Provider Details

I. General information

NPI: 1720360795
Provider Name (Legal Business Name): MINDEN PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 HOMER RD
MINDEN LA
71055-2933
US

IV. Provider business mailing address

504 TEXAS ST STE 200
SHREVEPORT LA
71101-3526
US

V. Phone/Fax

Practice location:
  • Phone: 318-377-8855
  • Fax: 318-371-1170
Mailing address:
  • Phone: 318-226-8202
  • Fax: 318-377-8852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number118
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateNULL

VIII. Authorized Official

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