Healthcare Provider Details

I. General information

NPI: 1952944894
Provider Name (Legal Business Name): RED RIVER MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LINE AVE
SHREVEPORT LA
71101-4639
US

IV. Provider business mailing address

1110 KEYSTONE CIR
BOSSIER CITY LA
71111-2178
US

V. Phone/Fax

Practice location:
  • Phone: 318-213-3800
  • Fax: 318-213-3357
Mailing address:
  • Phone: 318-469-7315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH R. TYNES
Title or Position: M.D.
Credential:
Phone: 318-469-7315