Provider Demographics
NPI:1083156632
Name:CYNTHIA P. BIMLE, MD, APMC
Entity Type:Organization
Organization Name:CYNTHIA P. BIMLE, MD, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-324-0111
Mailing Address - Street 1:107 CONTEMPO AVE
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5382
Mailing Address - Country:US
Mailing Address - Phone:318-324-0111
Mailing Address - Fax:318-324-9679
Practice Address - Street 1:107 CONTEMPO AVE
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5382
Practice Address - Country:US
Practice Address - Phone:318-324-0111
Practice Address - Fax:318-324-9679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12124R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1697117Medicaid
LA1697117Medicaid