Organization Name: | RED RIVER PEDIATRIC CLINIC, LLC |
NPI Number: | 1023167731 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | NATALIE MCCONNELL (OWNER) |
Mailing Address: | 1801 Fairfield Ave Suite 305 Shreveport |
State: | LA US |
Postal Code: | 711014443 |
Phone Number: | 3182212900 |
Fax Number: | 3182212999 |
NPI Enumeration Date: | 01/10/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |