| Red River Health, Llc | |
|
1550 Moores Ln Ste E Texarkana TX 75503-4657 | |
| (903) 792-7435 | |
| Not Available |
| Full Name | Red River Health, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1550 Moores Ln Ste E, Texarkana, Texas |
| Authorized Official Name and Position | Robin Brule (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 9037927435 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Red River Health, Llc 1550 Moores Ln Ste E Texarkana TX 75503-4657 Ph: () - | Red River Health, Llc 1550 Moores Ln Ste E Texarkana TX 75503-4657 Ph: (903) 792-7435 |
| NPI Number | 1205552130 |
|---|---|
| Provider Enumeration Date | 10/12/2022 |
| Last Update Date | 05/25/2023 |
| Medicare PECOS PAC ID | 7416320783 |
|---|---|
| Medicare Enrollment ID | O20230404002594 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205552130 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | Bryan D Bowen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770578072 PECOS PAC ID: 6305749649 Enrollment ID: I20040326000536 |
| Provider Name | Tara Lamm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952866626 PECOS PAC ID: 3870929979 Enrollment ID: I20200210000999 |
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