Healthcare Provider Details

I. General information

NPI: 1538432711
Provider Name (Legal Business Name): MINDEN PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2012
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 OFFICE PARK DR
MINDEN LA
71055-3086
US

IV. Provider business mailing address

102 OFFICE PARK DR
MINDEN LA
71055-3086
US

V. Phone/Fax

Practice location:
  • Phone: 318-377-2885
  • Fax: 318-377-2886
Mailing address:
  • Phone: 318-377-2885
  • Fax: 318-377-2886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JESS JUDY
Title or Position: PRESIDENT
Credential:
Phone: 615-372-8500