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General NPI Number Information
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NPI Number | 1952944894
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Entity Type | Organization
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Legal Business Name | RED RIVER MEDICINE, LLC
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Dates
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Enumeration Date | 10/23/2019
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 1500 LINE AVE
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City | SHREVEPORT
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State | LA
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Zip | 71101-4639
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Country | US
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Telephone | 318-213-3800
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Fax | 318-213-3357
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Provider Business Mailing Address
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Address Line | 1110 KEYSTONE CIR
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City | BOSSIER CITY
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State | LA
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Zip | 71111-2178
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Country | US
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Telephone | 318-469-7315
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Fax |
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Authorized Official
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Title or Position | M.D.
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Name | DR. JOSEPH R. TYNES
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Credential |
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Telephone | 318-469-7315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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