Provider Demographics
NPI:1699392589
Name:MINDEN PHYSICIAN PRACTICES LLC
Entity Type:Organization
Organization Name:MINDEN PHYSICIAN PRACTICES LLC
Other - Org Name:MINDEN MEDICAL CLINIC OF HAUGHTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-382-7296
Mailing Address - Street 1:170 HEALTHCARE PLAZA
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:170 HEALTHCARE PLAZA
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037
Practice Address - Country:US
Practice Address - Phone:318-706-0022
Practice Address - Fax:318-706-0023
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINDEN PHYSICIAN PRACTICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-26
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty