1427048743 NPI number — RED RIVER HOSPITAL, LLC

Table of content: (NPI 1427048743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427048743 NPI number — RED RIVER HOSPITAL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RED RIVER HOSPITAL, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RED RIVER HOSPITAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427048743
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6100 TOWER CIR STE 1000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37067-1509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-861-6000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1505 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICHITA FALLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76301-3106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-322-3171
Provider Business Practice Location Address Fax Number:
940-766-2883
Provider Enumeration Date:
10/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FARLEY
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
VP & SECRETARY
Authorized Official Telephone Number:
615-861-6000

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , with the licence number:  008749 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 121833104 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH6596 . This is a "BCBS OUTPATIENT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HH0683 . This is a "BCBS PSYCH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HH3683 . This is a "BCBS CHEMICAL DEPENDENCY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 021229201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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