Provider Demographics
NPI:1073716189
Name:MINDEN ORTHOPAEDICS & REHAB SERVICES, LLC
Entity Type:Organization
Organization Name:MINDEN ORTHOPAEDICS & REHAB SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:W
Authorized Official - Last Name:THORNHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-377-4340
Mailing Address - Street 1:PO BOX 1579
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71058-1579
Mailing Address - Country:US
Mailing Address - Phone:318-377-4340
Mailing Address - Fax:318-377-4348
Practice Address - Street 1:216 W UNION ST
Practice Address - Street 2:SUITE A
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-3216
Practice Address - Country:US
Practice Address - Phone:318-377-4340
Practice Address - Fax:318-377-4348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD024062207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5CM75Medicare ID - Type UnspecifiedGROUP #