Provider Demographics
NPI:1083841688
Name:JOE BEN HOLDEN M.D., LLC
Entity Type:Organization
Organization Name:JOE BEN HOLDEN M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR/PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-788-0832
Mailing Address - Street 1:421 NORTH AVENUE F
Mailing Address - Street 2:P.O. BOX 2098
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70537-2098
Mailing Address - Country:US
Mailing Address - Phone:337-788-0832
Mailing Address - Fax:337-783-6210
Practice Address - Street 1:421 NORTH AVENUE F
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70537-2098
Practice Address - Country:US
Practice Address - Phone:337-788-0832
Practice Address - Fax:337-783-6210
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOE BEN HOLDEN M.D., LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0079577208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1427020825Medicaid