Provider Demographics
NPI:1316728736
Name:RED STICK PHYSICIANS GROUP LLC
Entity type:Organization
Organization Name:RED STICK PHYSICIANS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KALEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:225-978-4264
Mailing Address - Street 1:12011 BRICKSOME AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2994
Mailing Address - Country:US
Mailing Address - Phone:225-713-4050
Mailing Address - Fax:225-713-4050
Practice Address - Street 1:12011 BRICKSOME AVE STE B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2994
Practice Address - Country:US
Practice Address - Phone:225-713-4050
Practice Address - Fax:225-713-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care