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Minden Physician Practices LLC

Organization Active NPI Rural Health Clinic/Center · Minden, LA

NPI 1720360795 · NPPES record last updated Aug 19, 2020

Key facts

NPI
1720360795
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
License
118 (LA)
Legal business name
MINDEN PHYSICIAN PRACTICES LLC
Practice address
427 Homer Rd
Minden, LA 71055-2933
Phone
(318) 377-8855
Fax
(318) 371-1170
NPI assigned
Sep 15, 2011
Organization subpart
Yes
Parent organization (as reported)
MINDEN PHYSICIAN PRACTICES LLC

Authorized official

Name
Shannon Dawn Brown
Title
Director
Phone
(318) 382-7296

Owners & managing parties with NPI records 3

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

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 3

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Facilities with the same owner 54

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 54

Practitioners 60

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

View all 60

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in LA

Rural health clinic certification: CCN 193879

Legal name
MINDEN PHYSICIAN PRACTICES LLC
Doing business as
THE WOMEN'S CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 22, 2007
Last certification
Oct 16, 2018
Ownership / control type
1A
Most recent change of ownership
Oct 1, 2011 (1 total)
Organization structure
LLC · Proprietary
Incorporated
May 11, 2009 in DE
Enrollment address
427 Homer Rd
Minden, LA 71055-2933

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
Donald Cameron
Individual 		5% Or Greater Indirect Ownership Interest
Member/Officer		 Aug 1, 2018 16%
Corporate Officer
Member/Officer		 Aug 1, 2018
Operational/Managerial Control
Member/Officer		 Aug 1, 2018
Rock Bordelon
Individual 		5% Or Greater Indirect Ownership Interest
Member		 Aug 1, 2018 80%
Allegiance Health Management Inc
Organization · Bossier City, LA
Corporation, Management services company, For-profit 		Operational/Managerial Control Aug 1, 2018
CLHG - Minden, LLC
Organization · Shreveport, LA
LLC, For-profit 		5% Or Greater Direct Ownership Interest Aug 1, 2018 100%
Cameron Investments LLC
Organization · Shreveport, LA
LLC, For-profit 		5% Or Greater Indirect Ownership Interest Aug 1, 2016 16%
Jim R Williams
Individual 		Corporate Director
Ceo		 Oct 1, 2019
W-2 Managing Employee
Ceo		 Oct 1, 2019

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20090930000103 LA Part B Supplier - Clinic/Group Practice 4789720004 Receives reassigned benefits from 91 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Minden, LA; Ringgold, LA; Haughton, LA
O20111110000704 LA Part a Provider - Rural Health Clinic 4789720004 Practice locations: Minden, LA

National Provider Directory

Tax ID family
Minden Physician Practices (4 organizations share this tax ID)
Part of
Minden Physician Practices

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207V00000X
Rural Health Clinic/Center 261QR1300X 118 LA Yes

Addresses

Primary practice location

427 Homer Rd
Minden, LA 71055-2933

Mailing address

504 Texas St Ste 200
Shreveport, LA 71101-3526
Phone (318) 226-8202

Other identifiers

IdentifierTypeStateIssuer
1108294MedicaidLA

Other names

  • THE WOMEN'S CLINIC Doing business as

Other providers in Minden, LA

All providers in Minden, LA · Rural Health Clinic/Center in Louisiana

Sources for this page

Verify at the official NPI Registry.