WK Shreveport Center for Geriatric Health

Primary specialty

Geriatric Psychiatry PhysicianTaxonomy code 2084P0805X

Legal business name

WK SHREVEPORT CENTER FOR GERIATRIC HEALTH

Practice address

2508 Bert Kouns Loop
Suite 303
Shreveport, LA 71118-3133

Phone

(318) 212-5850

Fax

(318) 212-5855

NPI assigned

Dec 16, 2009

Last updated

Jan 23, 2014By the provider in NPPES

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

Other identifiers 2

Member of 1

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

• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1568461572

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kendall Thomas Pilgreen, P.A.-C

  • Physician Assistant
  • Shreveport, LA
  • NPI 1174959779
  NPD (past)

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

{
    "created_epoch": "1260921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390435200000",
    "number": "1114256476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2508 BERT KOUNS LOOP",
            "address_2": "SUITE 303",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183133",
            "telephone_number": "318-212-5850",
            "fax_number": "318-212-5855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2508 BERT KOUNS LOOP",
            "address_2": "SUITE 303",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183133",
            "telephone_number": "318-212-5850",
            "fax_number": "318-212-5855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK SHREVEPORT CENTER FOR GERIATRIC HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-16",
        "last_updated": "2014-01-23",
        "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": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "5DL73",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1818798",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• WK Rheumatology Pierremont
• WK River Cities Interventional Pain
• WK Robotic and Laparoscopic Surgery Clinic
• WK Shreveport Behavioral Wellness Center
• WK Shreveport Breast Center
• WK Shreveport Infectious Disease
• WK Shreveport Internal Medicine
• WK Shreveport Sleep Medicine
• WK Signature Urology Clinic
• WK South Audiology Center

• Geriatric Psychiatry Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Geriatric Psychiatry Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.