Provider Demographics
NPI:1245403880
Name:RED RIVER MEDICAL, LLC
Entity Type:Organization
Organization Name:RED RIVER MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:OPA
Authorized Official - Phone:918-633-3006
Mailing Address - Street 1:414 E 124TH ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-4971
Mailing Address - Country:US
Mailing Address - Phone:918-633-3006
Mailing Address - Fax:918-398-6072
Practice Address - Street 1:6802 S OLYMPIA AVE
Practice Address - Street 2:STE 275
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-1823
Practice Address - Country:US
Practice Address - Phone:918-398-6077
Practice Address - Fax:918-398-6072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies