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Organization
JCT MEDICAL CONSULTING
Active
Organization
JCT MEDICAL CONSULTING
Active
Other names
JCT MEDICAL/RUSSELL W. TYNES MD
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL W. TYNES MD (MEDICAL DIRECTOR)
(318) 212-1610
Entity
Organization
Contact information
Practice address
460 ASHLEY RIDGE BLVD STE 500, SHREVEPORT, LA 71106-7228
(318) 212-1610
(866) 455-7515
Mailing address
460 ASHLEY RIDGE BLVD STE 500, SHREVEPORT, LA 71106-7228
(318) 212-1610
(866) 455-7515
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
016884
LA
Other
Enumeration date
09/19/2007
Last updated
04/29/2009
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