MEDICARE: RED RIVER ORTHOTIC SPECIALISTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1235139098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED RIVER ORTHOTIC SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	820 JORDAN ST
Second Line	:	SUITE 110
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-4518
Country	:	US
Telephone Number	:	318-226-4546
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 JORDAN ST
Second Line	:	SUITE 110
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-4518
Country	:	US
Telephone Number	:	318-226-4546
Fax Number	:

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	08/22/2020

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