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General NPI Number Information
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NPI Number | 1063826808
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Entity Type | Organization
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Legal Business Name | MINDEN PHYSICIAN PRACTICES LLC
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Dates
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Enumeration Date | 06/19/2014
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 2001 DOCTORS DR
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City | SPRINGHILL
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State | LA
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Zip | 71075-4526
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Country | US
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Telephone | 318-377-8855
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1095
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City | MINDEN
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State | LA
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Zip | 71058-1095
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Country | US
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Telephone | 318-377-8855
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESS N JUDY
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Credential |
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Telephone | 615-920-7212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | DPM.200064
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License Number State | LA
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