RED RIVER ARMY DEPOT (NPI# 1336340777) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336340777 |
| Entity Type | Organization |
| Organization Name | RED RIVER ARMY DEPOT |
| Practice Address |
9403 Evergreen Dr Shreveport LA 71118-3935 |
| Mailing Address |
9403 Evergreen Drive Shreveport LA 71118 |
| Practice Telephone | 3183932243 |
| Mailing Telephone | 3183932243 |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. TROY ROSS (CHIEF MEDICAL OFFICER) |
| Authorized Official Telephone | 9033342155 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171000000X | Military Health Care Provider | 13698 | OK | Other Service Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | RED RIVER ARMY DEPOT | 100 James Carlow Dr # 468, Texarkana, TX 75507-0001 |
| Street Address |
9403 EVERGREEN DR |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71118-3935 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720620784 | Wk Center for Pediatric Gastroenterology | Pediatrics | Wk Center for Pediatric Gastroenterology, 2530 Bert Kouns Industrial Loop, Ste 113, Shreveport, LA 71118 | 2019-10-11 |
| 1306302443 | Diamond Marie Willis | Case Manager/Care Coordinator | 9403 Mansfield Rd., Shreveport, LA 71118 | 2019-02-13 |
| 1194224469 | Latosa Hall | Case Manager/Care Coordinator | 9007 Letha Loop, Shreveport, LA 71118 | 2018-02-01 |
| 1902321623 | Bersheika Lashay Player | Counselor | 9403 Mansfield Road, Shreveport, LA 71118 | 2017-08-03 |
| 1518487149 | Clarke Jackson | Case Manager/Care Coordinator | 9730 Baird Rd Apt 2310, Shreveport, LA 71118 | 2017-06-24 |
| 1770010449 | Darrie'l Smith | Counselor | 2715 Mackey, Shreveport, LA 71118 | 2017-05-12 |
| 1760917041 | Delilah Wells | Case Manager/Care Coordinator | 9005 Walker Rd Apt 722, Shreveport, LA 71118 | 2017-04-25 |
| 1790229664 | We Care Transporttion Services LLC | Secured Medical Transport (VAN) | 2529 Summer Grove Dr, Shreveport, LA 71118 | 2016-12-13 |
| 1063955128 | Commanisha Smith | Social Worker | 2715 Mackey Place, Shreveport, LA 71118 | 2016-11-22 |
| 1023560802 | Yasmin Newman | Counselor | 9812 West Trails End, Shreveport, LA 71118 | 2016-10-27 |
| Find all providers in zip 71118 | ||||
| Taxonomy Code | 171000000X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |
| Notes: [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194871731 | Jessica Jamison | Military Health Care Provider | 7505 Pines Rd Ste 1255, Shreveport, LA 71129-3923 | 2007-01-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700186434 | Devin Anthony Keeton | Military Health Care Provider | 759 Pinetree St, Slidell, LA 70458-4413 | 2010-10-28 |
| 1003079195 | Christopher Lynn Anderson | Military Health Care Provider | 1790 Saturn Blvd, New Orleans, LA 70129 | 2008-07-08 |
| 1013534783 | James T Bridges | Military Health Care Provider | 2439 Manhattan Blvd, Harvey, LA 70058-5328 | 2020-06-29 |
| 1366938151 | Saudia Fatima Dolliole | Military Health Care Provider | 4300 S I 10 Service Rd W Ste 215, Metairie, LA 70001-7436 | 2018-07-05 |
| 1033516042 | Gina Markle | Military Health Care Provider | 1790 Saturn Blvd, New Orleans, LA 70129 | 2014-11-20 |
| 1619202520 | Suzanne Noland Hammel | Military Health Care Provider | 122 Sierra Ct, Metairie, LA 70001-5326 | 2009-10-09 |
| 1366611055 | United States Coast Guard | Military Health Care Provider | 13800 Old Gentilly Rd, New Orleans, LA 70129-2218 | 2008-02-27 |
| 1043401607 | Jesse Andrew Walton | Military Health Care Provider | 13800 Old Gentilly Rd, Medical Division, New Orleans, LA 70129-2218 | 2007-08-07 |
| 1326012949 | Daniel James Feeney | Military Health Care Provider | 243 Curtiss Rd Ste 100, Barksdale Afb, Barksdale Afb, LA 71110-2425 | 2006-02-13 |
| City | SHREVEPORT |
| Zip Code | 71118 |
Please comment or provide details below to improve the information on RED RIVER ARMY DEPOT.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.