Healthcare Provider Details

I. General information

NPI: 1043146509
Provider Name (Legal Business Name): THE VIDRINE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 MEADOW DR
OAKDALE LA
71463-2305
US

IV. Provider business mailing address

207 W DIXIE ST
OAKDALE LA
71463-3111
US

V. Phone/Fax

Practice location:
  • Phone: 318-491-2065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES VIDRINE
Title or Position: MD/OWNER
Credential: MD
Phone: 318-491-2065