Provider Demographics
NPI:1225002124
Name:MINDEN FAMILY CARE CENTER, LLC
Entity type:Organization
Organization Name:MINDEN FAMILY CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:NIDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-377-8260
Mailing Address - Street 1:208 MORRIS DR
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-3053
Mailing Address - Country:US
Mailing Address - Phone:318-377-8260
Mailing Address - Fax:318-377-9053
Practice Address - Street 1:208 MORRIS DR
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-3053
Practice Address - Country:US
Practice Address - Phone:318-377-8260
Practice Address - Fax:318-377-9053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1944645Medicaid
B60447Medicare UPIN
LA1944645Medicaid
B62040Medicare UPIN