# JCT MEDICAL CONSULTING

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- **Entity:** Organization
- **Status:** Active
- **Other names:** JCT MEDICAL/RUSSELL W. TYNES MD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205022647
- **Authorized official:** DR. RUSSELL W. TYNES MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (318) 212-1610

## Contact information

- **Practice address:** 460 ASHLEY RIDGE BLVD STE 500, SHREVEPORT, LA 71106-7228
- **Practice address phone:** (318) 212-1610
- **Practice address fax:** (866) 455-7515
- **Mailing address:** 460 ASHLEY RIDGE BLVD STE 500, SHREVEPORT, LA 71106-7228
- **Mailing address phone:** (318) 212-1610
- **Mailing address fax:** (866) 455-7515

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 016884 | LA | Yes |

## Other

- **Enumeration date:** 09/19/2007
- **Last updated:** 04/29/2009