Healthcare Provider Details

I. General information

NPI: 1063826808
Provider Name (Legal Business Name): MINDEN PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 DOCTORS DR
SPRINGHILL LA
71075-4526
US

IV. Provider business mailing address

PO BOX 1095
MINDEN LA
71058-1095
US

V. Phone/Fax

Practice location:
  • Phone: 318-377-8855
  • Fax:
Mailing address:
  • Phone: 318-377-8855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDPM.200064
License Number StateLA

VIII. Authorized Official

Name: JESS N JUDY
Title or Position: PRESIDENT
Credential:
Phone: 615-920-7212