Provider Demographics
NPI:1316816390
Name:RED TIDE RE LLC
Entity type:Organization
Organization Name:RED TIDE RE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-990-2204
Mailing Address - Street 1:9709 LAKESIDE BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77381-1216
Mailing Address - Country:US
Mailing Address - Phone:713-489-2198
Mailing Address - Fax:713-489-2978
Practice Address - Street 1:10 ENTERPRISE BLVD STE 109
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3534
Practice Address - Country:US
Practice Address - Phone:864-813-7226
Practice Address - Fax:864-556-7552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-30
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty