Provider Demographics
NPI:1861442170
Name:RED RIVER FAMILY PRACTICE LLP
Entity Type:Organization
Organization Name:RED RIVER FAMILY PRACTICE LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-476-6555
Mailing Address - Street 1:900 E 30TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-3326
Mailing Address - Country:US
Mailing Address - Phone:512-476-6555
Mailing Address - Fax:512-476-5611
Practice Address - Street 1:900 E 30TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3326
Practice Address - Country:US
Practice Address - Phone:512-476-6555
Practice Address - Fax:512-476-5611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00K32DOtherBLUE CROSS/BLUE SHIELD TX
TX00K32DOtherBLUE CROSS/BLUE SHIELD TX