NPI 1336340777

Red River Army Depot

Organisation Military Health Care Provider Shreveport, LA

Practice location

Address: 9403 Evergreen Dr, Shreveport, LA 71118-3935
Phone: (318) 393-2243
Mailing address: 9403 Evergreen Drive, Shreveport, LA 71118

Authorised official

Name: Troy Ross
Title: Chief Medical Officer
Phone: (903) 334-2155

Registered specialties

Military Health Care Provider Primary

Other Service Providers Taxonomy 171000000X Licence 13698 (OK)

Other Military Health Care Provider providers in Louisiana →

Registry record

NPI: 1336340777
Entity type: Organization
NPI issued: 31 May 2007
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.