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General NPI Number Information
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NPI Number | 1023167731
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Entity Type | Organization
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Legal Business Name | RED RIVER PEDIATRIC CLINIC, LLC
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1801 FAIRFIELD AVE SUITE 305
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City | SHREVEPORT
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State | LA
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Zip | 71101-4443
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Country | US
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Telephone | 318-221-2900
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Fax | 318-221-2999
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Provider Business Mailing Address
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Address Line | 1801 FAIRFIELD AVE SUITE 305
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City | SHREVEPORT
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State | LA
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Zip | 71101-4443
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Country | US
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Telephone | 318-221-2900
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Fax | 318-221-2999
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Authorized Official
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Title or Position | OWNER
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Name | NATALIE MCCONNELL
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Credential | M.D.
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Telephone | 318-221-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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