NPIMap

Organization Active NPI

Minden Family Care Center, LLC

  • Rural Health Clinic/Center
  • Minden, LA
National Provider Identifier
1225002124
Registry record updated Apr 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MINDEN FAMILY CARE CENTER, LLC
Practice address
208 Morris Dr
Minden, LA 71055-3053
Phone
(318) 377-8260
Fax
(318) 377-9053
NPI assigned
Feb 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Joseph Nida, MDNPI 1942273776
Title
Medical Director
Phone
(318) 377-8260

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

208 Morris Dr
Minden, LA 71055-3053

Mailing address

208 Morris Dr
Minden, LA 71055-3053
Phone (318) 377-8260

Other identifiers 1

IdentifierTypeStateIssuer
1944645MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090218000378 LA Part A Provider - Rural Health Clinic 1456337658 Practice locations: Minden, LA
O20230508002840 LA Part B Supplier - Clinic/Group Practice 1456337658 Receives reassigned benefits from 4 practitioners
Practice locations: Minden, LA

Rural health clinic certification: CCN 193811

Legal name
MINDEN FAMILY CARE CENTER, LLC
Doing business as
MINDEN FAMILY CARE CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 10, 1995
Last certification
Dec 9, 2021
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Dec 7, 1994 in LA
Enrollment address
208 Morris Drive
Minden Family Care Center
Minden, LA 71055-3053

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D0897298Minden Family Care Center, Apmc208 Morris Drive, Minden, LA 71055Certificate of waiverJan 13, 2028

National Provider Directory

National Provider Directory

Locations

208 Morris Dr
Minden, LA 71055
Phone (318) 377-8260

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EGEDAD

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Brittney Gamel Individual 5% Or Greater Direct Ownership Interest Jun 19, 2017 25%
Corporate Director Jun 19, 2017 100%
W-2 Managing Employee Jun 19, 2017 100%
Brook-Lyn Bolin Individual 5% Or Greater Direct Ownership InterestManager Jun 19, 2017 25%
Cheryl Johnson Individual W-2 Managing EmployeeAd; Mar 5, 2012 100%
Operational/Managerial Control Mar 5, 2012 100%
William Fleming Individual 5% Or Greater Direct Ownership Interest Jun 19, 2017 25%
Corporate DirectorMedical Director Jun 19, 2017
Joseph R Nida Individual Corporate DirectorMedical Director Jun 19, 2017 100%
John C Fleming Individual Corporate Director Jun 19, 2017 25%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682467200000",
    "number": "1225002124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 MORRIS DR",
            "city": "MINDEN",
            "state": "LA",
            "postal_code": "710553053",
            "telephone_number": "318-377-8260",
            "fax_number": "318-377-9053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 MORRIS DR",
            "city": "MINDEN",
            "state": "LA",
            "postal_code": "710553053",
            "telephone_number": "318-377-8260",
            "fax_number": "318-377-9053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDEN FAMILY CARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-15",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "status": "A",
        "authorized_official_last_name": "NIDA",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "318-377-8260",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1944645",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minden, LA

Sources for this page

Verify at the official NPI Registry.