Provider Demographics
NPI:1699001594
Name:RED RIVER PAIN SOLUTIONS
Entity Type:Organization
Organization Name:RED RIVER PAIN SOLUTIONS
Other - Org Name:TEXAMEDEQ
Other - Org Type:Other Name
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:OPA, CO
Authorized Official - Phone:918-633-3006
Mailing Address - Street 1:414 E 124TH ST S
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-4971
Mailing Address - Country:US
Mailing Address - Phone:918-633-3006
Mailing Address - Fax:918-298-6338
Practice Address - Street 1:414 E 124TH ST S
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-4971
Practice Address - Country:US
Practice Address - Phone:918-633-3006
Practice Address - Fax:918-298-6338
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOONER HOLDINGS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0104057332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies