Healthcare Provider Details

I. General information

NPI: 1265777957
Provider Name (Legal Business Name): MINDEN PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N MONROE ST STE B
MINDEN LA
71055-3332
US

IV. Provider business mailing address

PO BOX 5859
BELFAST ME
04915-5800
US

V. Phone/Fax

Practice location:
  • Phone: 318-382-4900
  • Fax:
Mailing address:
  • Phone: 318-382-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
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