Healthcare Provider Details

I. General information

NPI: 1235139098
Provider Name (Legal Business Name): RED RIVER ORTHOTIC SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 JORDAN ST SUITE 110
SHREVEPORT LA
71101-4518
US

IV. Provider business mailing address

820 JORDAN ST SUITE 110
SHREVEPORT LA
71101-4518
US

V. Phone/Fax

Practice location:
  • Phone: 318-226-4546
  • Fax:
Mailing address:
  • Phone: 318-226-4546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. ROY LEWIS RIDING
Title or Position: OWNER/PRACTITIONER
Credential: C.O.
Phone: 318-226-4546