Provider Demographics
NPI:1528351848
Name:RED RIVER PAIN MANAGEMENT
Entity type:Organization
Organization Name:RED RIVER PAIN MANAGEMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-261-3600
Mailing Address - Street 1:10740 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 275
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2161
Mailing Address - Country:US
Mailing Address - Phone:214-261-3600
Mailing Address - Fax:
Practice Address - Street 1:10740 N CENTRAL EXPY
Practice Address - Street 2:SUITE 275
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2161
Practice Address - Country:US
Practice Address - Phone:214-261-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LONESTAR MULTICARE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty