NPIMap

Organization Active NPI

Red River Pharmacy Long Term Care, LLC

  • Home Infusion Therapy Pharmacy
  • Tyler, TX
National Provider Identifier
1497317366
Registry record updated Aug 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Infusion Therapy PharmacyTaxonomy code 3336H0001X
Legal business name
RED RIVER PHARMACY LONG TERM CARE, LLC
Practice address
4801 Troup Hwy Ste 401
Tyler, TX 75703-2358
Phone
(903) 617-6885
NPI assigned
Jul 1, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2021

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

Authorized official

Name
Robin Brule
Title
Director of Business
Phone
(903) 792-7435

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Home Infusion Agency 251F00000X
Durable Medical Equipment & Medical Supplies 332B00000X
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X
Home Infusion Therapy Pharmacy 3336H0001X Primary

Addresses

Primary practice location

4801 Troup Hwy Ste 401
Tyler, TX 75703-2358

Mailing address

1550 Moores LN Ste a
Texarkana, TX 75503-4657

Other names 1

  • Red River Infusion Pharmacy of Tyler Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Surescript

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200109000073 TX DME Supplier - Pharmacy 2860827417 Practice locations: Tyler, TX

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Red River Pharm LTC LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1550 Moores Ln
Ste A
Texarkana, TX 75503
Phone (903) 792-1721

4801 Troup Hwy
Ste 401
Tyler, TX 75703
Phone (903) 617-6885

NPI Registry JSON

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

{
    "created_epoch": "1561939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629936000000",
    "number": "1497317366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 MOORES LN STE A",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755034657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 TROUP HWY STE 401",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757032358",
            "telephone_number": "903-617-6885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RED RIVER PHARMACY LONG TERM CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-01",
        "last_updated": "2021-08-26",
        "certification_date": "2021-08-26",
        "status": "A",
        "authorized_official_last_name": "BRULE",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "DIRECTOR OF BUSINESS",
        "authorized_official_telephone_number": "903-792-7435"
    },
    "taxonomies": [
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Surescript",
            "affiliation": "N",
            "address_1": "4801 Troup Hwy Ste 402",
            "city": "Tyler",
            "state": "TX",
            "country_code": "US",
            "postal_code": "757032358",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Red River Infusion Pharmacy of Tyler",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.