Provider Demographics
NPI:1407492184
Name:MD CLINICS LLC
Entity Type:Organization
Organization Name:MD CLINICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF OPERATIONS
Authorized Official - Prefix:MISS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:213-238-8241
Mailing Address - Street 1:PO BOX 4506
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71134-0506
Mailing Address - Country:US
Mailing Address - Phone:318-239-4860
Mailing Address - Fax:318-202-8707
Practice Address - Street 1:10600 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-5105
Practice Address - Country:US
Practice Address - Phone:318-239-4860
Practice Address - Fax:318-202-8707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2208888Medicaid
LAPST.023556OtherLOUISIANA BOARD OF PHARMACY
LAPHY.008014-IROtherLOUISIANA BOARD OF PHARMACY
LAMD-11219ROtherSTATE MEDICAL LICENSE - MANISH DHAWAN
LAPIC.023556OtherLOUISIANA BOARD OF PHARMACY