Provider Demographics
NPI:1942806260
Name:REDTAG-19, LLC
Entity Type:Organization
Organization Name:REDTAG-19, LLC
Other - Org Name:RED TAG-19 LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LATA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHINTRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-482-3740
Mailing Address - Street 1:8765 WATERCREST CIR E
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2853
Mailing Address - Country:US
Mailing Address - Phone:954-482-3740
Mailing Address - Fax:719-245-1341
Practice Address - Street 1:8765 WATERCREST CIR E
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-2853
Practice Address - Country:US
Practice Address - Phone:954-482-3740
Practice Address - Fax:719-245-1341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center