| Red River Medicine, Llc | |
|
1500 Line Ave Shreveport LA 71101-4639 | |
| (318) 213-3800 | |
| (318) 213-3357 |
| Full Name | Red River Medicine, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1500 Line Ave, Shreveport, Louisiana |
| Authorized Official Name and Position | Joseph R Tynes (MD/OWNER) |
| Authorized Official Contact | 3185490929 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Red River Medicine, Llc Po Box 52364 Shreveport LA 71135-2364 Ph: (318) 798-4606 | Red River Medicine, Llc 1500 Line Ave Shreveport LA 71101-4639 Ph: (318) 213-3800 |
| NPI Number | 1952944894 |
|---|---|
| Provider Enumeration Date | 10/23/2019 |
| Last Update Date | 01/07/2020 |
| Medicare PECOS PAC ID | 8022444942 |
|---|---|
| Medicare Enrollment ID | O20200212000774 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952944894 | NPI | - | NPPES |
| 1423611 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Joseph R Tynes |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306880778 PECOS PAC ID: 9335129527 Enrollment ID: I20040720000879 |
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