Healthcare Provider Details

I. General information

NPI: 1083156632
Provider Name (Legal Business Name): CYNTHIA P. BIMLE, MD, APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CONTEMPO AVE
WEST MONROE LA
71291-5382
US

IV. Provider business mailing address

107 CONTEMPO AVE
WEST MONROE LA
71291-5382
US

V. Phone/Fax

Practice location:
  • Phone: 318-324-0111
  • Fax: 318-324-9679
Mailing address:
  • Phone: 318-324-0111
  • Fax: 318-324-9679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12124R
License Number StateLA

VIII. Authorized Official

Name: VERONICA J. HOLSTEAD
Title or Position: OFFICE MANAGER
Credential:
Phone: 318-324-0111