Provider Demographics
NPI:1437589157
Name:REDMED, LLC
Entity Type:Organization
Organization Name:REDMED, LLC
Other - Org Name:REDMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-489-4044
Mailing Address - Street 1:12 BROOKS XING
Mailing Address - Street 2:
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863-1009
Mailing Address - Country:US
Mailing Address - Phone:662-489-4044
Mailing Address - Fax:662-489-4041
Practice Address - Street 1:12 BROOKS XING
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-1009
Practice Address - Country:US
Practice Address - Phone:662-489-4044
Practice Address - Fax:662-489-4041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care