Provider Demographics
NPI:1760538326
Name:LINDA C BUNCH MD APMC
Entity Type:Organization
Organization Name:LINDA C BUNCH MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:CAMILLE
Authorized Official - Last Name:BUNCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-388-0114
Mailing Address - Street 1:3602 CYPRESS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7314
Mailing Address - Country:US
Mailing Address - Phone:318-388-0114
Mailing Address - Fax:318-388-0954
Practice Address - Street 1:3602 CYPRESS ST
Practice Address - Street 2:SUITE A
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7314
Practice Address - Country:US
Practice Address - Phone:318-388-0114
Practice Address - Fax:318-388-0954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018178207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1354708Medicaid
LAB63905Medicare UPIN
LA5896710001Medicare NSC
LA52499DQ60Medicare PIN
LA1354708Medicaid