Provider Demographics
NPI:1235139098
Name:RED RIVER ORTHOTIC SPECIALISTS, LLC
Entity Type:Organization
Organization Name:RED RIVER ORTHOTIC SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:RIDING
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:318-226-4546
Mailing Address - Street 1:820 JORDAN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4518
Mailing Address - Country:US
Mailing Address - Phone:318-226-4546
Mailing Address - Fax:
Practice Address - Street 1:820 JORDAN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4518
Practice Address - Country:US
Practice Address - Phone:318-226-4546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier