Provider Demographics
NPI:1467571745
Name:RED RIVER SPINE ASSOCIATES, PC
Entity Type:Organization
Organization Name:RED RIVER SPINE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:E
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:701-280-0057
Mailing Address - Street 1:2829 UNIVERSITY DR S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6050
Mailing Address - Country:US
Mailing Address - Phone:701-280-0057
Mailing Address - Fax:701-365-0086
Practice Address - Street 1:2829 UNIVERSITY DR S
Practice Address - Street 2:SUITE 201
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6050
Practice Address - Country:US
Practice Address - Phone:701-280-0057
Practice Address - Fax:701-365-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5781204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND17106Medicaid
MN59680200Medicaid
4474OtherND BLUE SHIELD
NDCS9503OtherRR MEDICARE
4474OtherND BLUE SHIELD
NDN70279Medicare ID - Type Unspecified