Healthcare Provider Details

I. General information

NPI: 1548659808
Provider Name (Legal Business Name): RED RIVER LOCUMS LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 UNIVERSITY DR S
FARGO ND
58103-4169
US

IV. Provider business mailing address

PO BOX 1296
WARSAW IN
46581-1296
US

V. Phone/Fax

Practice location:
  • Phone: 701-237-9592
  • Fax: 701-298-3883
Mailing address:
  • Phone: 574-268-9640
  • Fax: 574-068-0684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR16475
License Number StateND

VIII. Authorized Official

Name: ROBERT J SPLICHAL
Title or Position: SECRETARY / TREASURER
Credential: CRNA
Phone: 574-268-9640