Organization
TRI-STATE MEDICAL CLINIC, APMC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD E. HAYNIE MD (PRESIDENT)
(318) 621-2929
Entity
Organization
Contact information
Practice address
2551 GREENWOOD RD, SUITE 410, SHREVEPORT, LA 71103-3981
(318) 621-2929
Mailing address
2551 GREENWOOD RD, SUITE 410, SHREVEPORT, LA 71103-3981
(318) 621-2929
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
LA
Other
Enumeration date
05/30/2006
Last updated
08/22/2020
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