Provider Demographics
NPI:1659418309
Name:RED RIVER PULMONARY CRITICAL CARE AND SLEEP DISORDERS CLINIC LLC
Entity Type:Organization
Organization Name:RED RIVER PULMONARY CRITICAL CARE AND SLEEP DISORDERS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAGHU
Authorized Official - Middle Name:
Authorized Official - Last Name:NATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-747-2277
Mailing Address - Street 1:2400 HOSPITAL DR
Mailing Address - Street 2:SUITE 340
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2385
Mailing Address - Country:US
Mailing Address - Phone:318-747-2277
Mailing Address - Fax:318-747-2217
Practice Address - Street 1:2400 HOSPITAL DR
Practice Address - Street 2:SUITE 340
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2385
Practice Address - Country:US
Practice Address - Phone:318-747-2277
Practice Address - Fax:318-747-2217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11049R207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CP08Medicare ID - Type UnspecifiedGROUP NUMBER