Provider Demographics
NPI:1629857248
Name:RED RIVER MEDICAL GROUP CORPORATION
Entity type:Organization
Organization Name:RED RIVER MEDICAL GROUP CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIGAR
Authorized Official - Middle Name:KANUBHAI
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-802-8056
Mailing Address - Street 1:1960 MADISON ST PMB 326
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8063
Mailing Address - Country:US
Mailing Address - Phone:931-538-3039
Mailing Address - Fax:931-245-5484
Practice Address - Street 1:1110 A TED CROZIER SR. BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8912
Practice Address - Country:US
Practice Address - Phone:931-538-3039
Practice Address - Fax:931-245-5484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-22
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty