RED RIVER MEDICINE, LLC (NPI# 1952944894) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952944894 |
| Entity Type | Organization |
| Organization Name | RED RIVER MEDICINE, LLC |
| Practice Address |
1500 Line Ave Shreveport LA 71101-4639 |
| Mailing Address |
Po Box 52364 Shreveport LA 71135-2364 |
| Practice Telephone | 3182133800 |
| Practice Fax Number | 3182133357 |
| Mailing Telephone | 3187984606 |
| Mailing Fax Number | 3187984601 |
| Enumeration Date | 2019-10-23 |
| Last Update Date | 2020-01-07 |
| Authorized Official Name | DR. JOSEPH R TYNES (MD/OWNER) |
| Authorized Official Telephone | 3185490929 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1423611 | 05 |
| Street Address |
1500 LINE AVE |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71101-4639 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164427829 | Stephen L. Cox | Orthopaedic Surgery | 1500 Line Ave, Suite 100, Shreveport, LA 71101-4644 | 2005-06-17 |
| 1659871887 | Valerie Taylor Thompson | Physical Therapist | 1500 Line Ave, Shreveport, LA 71101-4639 | 2018-02-14 |
| 1356892665 | Ryan D Elledge | Physician Assistant | 1500 Line Ave, Suite 200, Shreveport, LA 71101-4639 | 2016-10-21 |
| 1487109138 | Kristen Jones Brezina | Physician Assistant | 1500 Line Ave, Suite 100, Shreveport, LA 71101-4639 | 2016-08-23 |
| 1619328838 | Meghan Marie Williams | Occupational Therapist | 1500 Line Ave, Suite 100, Shreveport, LA 71101-4639 | 2016-06-29 |
| 1285023010 | Mca Specialists Hospital, LLC | Anesthesiology | 1500 Line Ave, Shreveport, LA 71101-4639 | 2015-01-16 |
| 1093131765 | Kelly Daniels | Physical Therapist | 1500 Line Ave, Shreveport, LA 71101-4639 | 2014-03-05 |
| 1245678432 | Laura Elise Bares | Physical Therapist | 1500 Line Ave, Suite 104, Shreveport, LA 71101-4639 | 2013-06-10 |
| 1710233721 | Elvira Cehajic | Nurse Practitioner | 1500 Line Ave, Ste 100, Shreveport, LA 71101-4639 | 2012-07-27 |
| 1437425162 | Stephanie G Candler | Specialist/Technologist, Other | 1500 Line Ave, Suite 200, Shreveport, LA 71101-4639 | 2012-03-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255988630 | Renee Jewitt | Case Manager/Care Coordinator | 1513 Line Avenue, Suite 225, Shreveport, LA 71101 | 2019-08-21 |
| 1942770094 | Bessie Larry | Case Manager/Care Coordinator | 1513 Line Av, 222, Shreveport, LA 71101 | 2018-12-03 |
| 1750875944 | Jarvis Decarleonne Larry | Community Health Worker | 1513 Line Ave # 222, Shreveport, LA 71101 | 2018-06-20 |
| 1871083485 | Kimberly B. Mcclelland, Lcsw | Counselor | 820 Jordan St. Ste 510w, Shreveport, LA 71101 | 2018-05-18 |
| 1982106456 | Hudson Amc LLC | Internal Medicine | 1800 Irving Place, Shreveport, LA 71101 | 2018-03-01 |
| 1528572955 | Spencer Ron Floyd | Counselor | 1717 Marshall Street, Shreveport, LA 71101 | 2017-11-21 |
| 1578088076 | Brittany Morris | Case Manager/Care Coordinator | 1835 Spring Street Annex Building, Shreveport, LA 71101 | 2017-08-07 |
| 1275058794 | Diane Williams | Case Manager/Care Coordinator | 217 Jones St Apt 510, Shreveport, LA 71101 | 2017-08-04 |
| 1386195972 | Jakeya Woodbury | Counselor | 453 Stoner Ave, Shreveport, LA 71101 | 2016-10-18 |
| 1922459643 | Arlene Huling | Counselor | 449 Egan Street, Shreveport, LA 71101 | 2016-06-23 |
| Find all providers in zip 71101 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790315026 | Cody Tingle Md LLC | Internal Medicine | 535 Pierremont Rd, Shreveport, LA 71106-2207 | 2020-01-26 |
| 1538654306 | Masri Group LLC | Internal Medicine | 3801 Creswell Ave Unit 19, Shreveport, LA 71106-1257 | 2018-06-25 |
| 1982106456 | Hudson Amc LLC | Internal Medicine | 1800 Irving Place, Shreveport, LA 71101 | 2018-03-01 |
| 1760923064 | Martin Marak | Internal Medicine | 847 Prospect St, Shreveport, LA 71104-3025 | 2017-03-20 |
| 1265883482 | Vari LLC | Internal Medicine | 506 Rock Hollow Dr, Shreveport, LA 71115-2502 | 2016-06-29 |
| 1598140121 | Mihir V Patel Md LLC | Internal Medicine | 9930 Loveland Ct, Shreveport, LA 71106-7795 | 2015-07-24 |
| 1619357209 | Chad Michael Gibson | Internal Medicine | 8001 Youree Dr Ste 4007, Shreveport, LA 71115-2302 | 2015-06-09 |
| 1265829394 | Amanda Lynn Callegan-poche' | Internal Medicine | 1023 Provenance Pl Ste 130, Shreveport, LA 71106-7796 | 2015-04-15 |
| 1699017681 | Deanna Elise Mossallati | Internal Medicine | 8551 Greenwood Rd, Suite 410, Shreveport, LA 71103 | 2013-03-18 |
| 1477807980 | Ronald Baylis George | Internal Medicine | 1821 Willow Point Drive, Shreveport, LA 71119 | 2012-11-06 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71101 |
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| 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.