NPIMap

Organization Active NPI

Minden Physician Practices LLC

Doing business as The Women's Clinic

  • Rural Health Clinic/Center
  • Minden, LA
National Provider Identifier
1720360795
Registry record updated Aug 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
118 Issued in LA
Legal business name
MINDEN PHYSICIAN PRACTICES LLC
Doing business as
The Women's Clinic
Practice address
427 Homer Rd
Minden, LA 71055-2933
Phone
(318) 377-8855
Fax
(318) 371-1170
NPI assigned
Sep 15, 2011
Last updated
Aug 19, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
MINDEN PHYSICIAN PRACTICES LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 19, 2020

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

Authorized official

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

Specialties & licenses 2

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

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 names 1

  • THE WOMEN'S CLINIC Doing business as

Medicare participation

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

Enrollment records 2

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720360795. Details of each certification follow.

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
LLCProprietary
Incorporated
May 11, 2009 in DE
Enrollment address
427 Homer Rd
Minden, LA 71055-2933

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Minden Physician Practices4 organizations share this tax ID, including this one
Part of
Minden Physician Practices

Other organizations with this 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.

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
Donald Cameron Individual 5% Or Greater Indirect Ownership InterestMember/Officer Aug 1, 2018 16%
Corporate OfficerMember/Officer Aug 1, 2018
Operational/Managerial ControlMember/Officer Aug 1, 2018
Rock Bordelon Individual 5% Or Greater Indirect Ownership InterestMember 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 DirectorCeo Oct 1, 2019
W-2 Managing EmployeeCeo Oct 1, 2019

Owners & managing parties with NPI records 3

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

Facilities with the same owner 54

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

View all 54

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1316044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597795200000",
    "number": "1720360795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 TEXAS ST STE 200",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711013526",
            "telephone_number": "318-226-8202",
            "fax_number": "318-377-8852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 HOMER RD",
            "city": "MINDEN",
            "state": "LA",
            "postal_code": "710552933",
            "telephone_number": "318-377-8855",
            "fax_number": "318-371-1170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDEN PHYSICIAN PRACTICES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MINDEN PHYSICIAN PRACTICES LLC",
        "enumeration_date": "2011-09-15",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "318-382-7296"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "LA",
            "license": "118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE WOMEN'S CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "THE WOMEN'S CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minden, LA

Sources for this page

Verify at the official NPI Registry.