Provider Demographics
NPI:1033725940
Name:RED RIVER DIAGNOSTICS, PLLC
Entity Type:Organization
Organization Name:RED RIVER DIAGNOSTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:VIKTOR
Authorized Official - Last Name:SILVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-589-8606
Mailing Address - Street 1:PO BOX 8219
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77387-8219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2516 PROVINE RD
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75072-3938
Practice Address - Country:US
Practice Address - Phone:713-589-8606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic NeuroimagingGroup - Single Specialty