Provider Demographics
NPI:1013433358
Name:RED RIVER NEUROSURGICAL
Entity Type:Organization
Organization Name:RED RIVER NEUROSURGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:VIKTOR
Authorized Official - Last Name:SILVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-814-1558
Mailing Address - Street 1:2516 PROVINE RD
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-3938
Mailing Address - Country:US
Mailing Address - Phone:903-814-1558
Mailing Address - Fax:
Practice Address - Street 1:600 E TAYLOR ST STE 304
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2880
Practice Address - Country:US
Practice Address - Phone:903-814-1558
Practice Address - Fax:903-957-1018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1605207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX662182766Medicaid