| Organization Name: | RED RIVER ARMY DEPOT |
| NPI Number: | 1336340777 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TROY ROSS (CHIEF MEDICAL OFFICER) |
| Mailing Address: | 9403 Evergreen Dr Shreveport |
| State: | LA US |
| Postal Code: | 711183935 |
| Phone Number: | 3183932243 |
| Fax Number: | |
| NPI Enumeration Date: | 05/31/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | 13698 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |