Provider Demographics
NPI:1558981472
Name:RED RIVER MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:RED RIVER MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:F
Authorized Official - Last Name:NORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-695-0101
Mailing Address - Street 1:4411 W GORE BLVD STE A2
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5977
Mailing Address - Country:US
Mailing Address - Phone:580-730-0510
Mailing Address - Fax:
Practice Address - Street 1:4411 W GORE BLVD STE A2
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5977
Practice Address - Country:US
Practice Address - Phone:580-730-0510
Practice Address - Fax:580-357-8787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty