Provider Demographics
NPI:1831135383
Name:RED RIVER VALLEY PATHOLOGY, PA
Entity Type:Organization
Organization Name:RED RIVER VALLEY PATHOLOGY, PA
Other - Org Name:RRV PATHOLOGY LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-784-7210
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75461-0100
Mailing Address - Country:US
Mailing Address - Phone:903-783-1437
Mailing Address - Fax:
Practice Address - Street 1:801 CLARKSVILLE ST
Practice Address - Street 2:SUITE C
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-0217
Practice Address - Country:US
Practice Address - Phone:903-784-7210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167960701Medicaid
OK200037250BMedicaid
TXCL5097OtherHMO BLUE
TXHMO BLUEOther0049DQ
TXBCBSOther0049DQ
TXCL5097OtherHMO BLUE
TXHMO BLUEOther0049DQ
TXCL5097OtherBCBS
=========OtherCHAMPUS