Red River Pediatric Clinic, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

RED RIVER PEDIATRIC CLINIC, LLC

Practice address

1801 Fairfield Ave
Suite 305
Shreveport, LA 71101-4443

Phone

(318) 221-2900

Fax

(318) 221-2999

NPI assigned

Jan 10, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Natalie McConnell, M.D.

Title

Owner

Phone

(318) 221-2900

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023167731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 FAIRFIELD AVE",
            "address_2": "SUITE 305",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014443",
            "telephone_number": "318-221-2900",
            "fax_number": "318-221-2999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 FAIRFIELD AVE",
            "address_2": "SUITE 305",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014443",
            "telephone_number": "318-221-2900",
            "fax_number": "318-221-2999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RED RIVER PEDIATRIC CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCCONNELL",
        "authorized_official_first_name": "NATALIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "318-221-2900",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1443646",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Red River Recovery & Physical Therapy
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• Red River Therapeutic Solutions
• Red River Therapeutic Solutions LLC
• Red River Therapeutic Soulutions

• Primary Care Clinic/Center in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Primary Care Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.