# TRI-STATE MEDICAL CLINIC, APMC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679520027
- **Authorized official:** RICHARD E. HAYNIE MD (PRESIDENT)
- **Authorized official phone:** (318) 621-2929

## Contact information

- **Practice address:** 2551 GREENWOOD RD, SUITE 410, SHREVEPORT, LA 71103-3981
- **Practice address phone:** (318) 621-2929
- **Mailing address:** 2551 GREENWOOD RD, SUITE 410, SHREVEPORT, LA 71103-3981
- **Mailing address phone:** (318) 621-2929

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | LA | Yes |

## Other

- **Enumeration date:** 05/30/2006
- **Last updated:** 08/22/2020