Provider Demographics
NPI:1548799380
Name:RED RIVER UROLOGY, PLLC
Entity Type:Organization
Organization Name:RED RIVER UROLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:903-706-5173
Mailing Address - Street 1:2850 LEWIS LANE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-6332
Mailing Address - Country:US
Mailing Address - Phone:903-706-5173
Mailing Address - Fax:903-706-5176
Practice Address - Street 1:2850 LEWIS LN STE 113
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-9378
Practice Address - Country:US
Practice Address - Phone:903-272-9391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty