Organization Active NPI

WK Digestive Disease Consultants

  • Gastroenterology Physician
  • Shreveport, LA
National Provider Identifier
1003285255
Registry record updated Sep 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
WK DIGESTIVE DISEASE CONSULTANTS
Practice address
2508 Bert Koun Loop
Sutie 304
Shreveport, LA 71118-3133
Phone
(318) 671-8880
Fax
(318) 671-8879
NPI assigned
Sep 17, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Greg J Gavin
Title
Network Administrator
Phone
(318) 212-8780

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

2508 Bert Koun Loop
Sutie 304
Shreveport, LA 71118-3133

Mailing address

2508 Bert Koun Loop
Sutie 304
Shreveport, LA 71118-3133
Phone (318) 671-8880

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151110000952 LA Part B Supplier - Clinic/Group Practice 2668782384 Receives reassigned benefits from 1 practitioner
Practice locations: Shreveport, LA

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2508 Bert Kouns Industrial Loop
Ste 304
Shreveport, LA 71118
Phone (318) 671-8880

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1442448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442534400000",
    "number": "1003285255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2508 BERT KOUN LOOP",
            "address_2": "SUTIE 304",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183133",
            "telephone_number": "318-671-8880",
            "fax_number": "318-671-8879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2508 BERT KOUN LOOP",
            "address_2": "SUTIE 304",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183133",
            "telephone_number": "318-671-8880",
            "fax_number": "318-671-8879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK DIGESTIVE DISEASE CONSULTANTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-17",
        "last_updated": "2015-09-18",
        "status": "A",
        "authorized_official_last_name": "GAVIN",
        "authorized_official_first_name": "GREG",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "NETWORK ADMINISTRATOR",
        "authorized_official_telephone_number": "318-212-8780"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.