WK Tots to Teens Pediatric Center

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

WK TOTS TO TEENS PEDIATRIC CENTER

Practice address

845 Olive St
Suite a
Shreveport, LA 71104-2141

Phone

(318) 226-4892

Fax

(318) 227-4927

NPI assigned

Aug 7, 2012

Organization subpart

No

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) 212-4232

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

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

• Willis Knighton Medical Center, Inc.

  • Skilled Nursing Facility
  • Shreveport, LA
  • NPI 1144267451

  Member Of

  NPD member

Locations

Practitioners 3

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

• Holly Alene Gill, M.D.

  • Pediatrics Physician
  • Shreveport, LA
  • NPI 1265459127
  NPD (past)
• Phillip Rozeman, MD

  • Cardiovascular Disease Physician
  • Shreveport, LA
  • NPI 1699740035
  NPD (past)
• Olabode Olaosebikan Desalu, MD

  • Pediatrics Physician
  • Rogers, AR
  • NPI 1093732950
  NPD (past)

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

{
    "created_epoch": "1344297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344297600000",
    "number": "1063769255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 OLIVE ST",
            "address_2": "SUITE A",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711042141",
            "telephone_number": "318-226-4892",
            "fax_number": "318-227-4927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 OLIVE ST",
            "address_2": "SUITE A",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711042141",
            "telephone_number": "318-226-4892",
            "fax_number": "318-227-4927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK TOTS TO TEENS PEDIATRIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-07",
        "last_updated": "2012-08-07",
        "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": "318-212-4232"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• WK South Surgical Hospitalists
• WK Spectrum Neurosurgery-the Brain & Spine Specialist
• WK Spine Clinic
• WK Spine Institute
• WK Surgical Consultants
• WK Transplant Physicians
• WK Tri-State Medical Clinic
• WK Tri-State Neurosurgery Associates
• WK Urgent Care Center-Pierremont
• WK Urgent Care Center-South

• Pediatrics Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Pediatrics Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.