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General NPI Number Information
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NPI Number | 1699001594
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Entity Type | Organization
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Legal Business Name | RED RIVER PAIN SOLUTIONS
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Dates
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Enumeration Date | 10/27/2009
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Last Update Date | 10/27/2009
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Provider Practice Location Address
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Address Line | 414 E 124TH ST S
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City | JENKS
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State | OK
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Zip | 74037-4971
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Country | US
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Telephone | 918-633-3006
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Fax | 918-298-6338
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Provider Business Mailing Address
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Address Line | 414 E 124TH ST S
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City | JENKS
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State | OK
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Zip | 74037-4971
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Country | US
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Telephone | 918-633-3006
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Fax | 918-298-6338
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | MRS. SUSAN MICHELLE ARMSTRONG
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Credential | OPA, CO
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Telephone | 918-633-3006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0104057
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License Number State | TX
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