WK North Orthopedic Clinic

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

Legal business name

WK NORTH ORTHOPEDIC CLINIC

Practice address

2751 Albert L Bicknell Dr
Suite 1-B
Shreveport, LA 71103-3920

Phone

(318) 212-8776

Fax

(318) 212-8774

NPI assigned

Dec 28, 2005

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 1

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

Practitioners 6

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

• Lauren Gernand Banet, PA-C

  • Physician Assistant
  • Bossier City, LA
  • NPI 1922348887
  NPD (past)
• Stafford R Long, PA-C

  • Surgical Physician Assistant
  • Shreveport, LA
  • NPI 1851343396
  NPD (past)
• William L Overdyke, MD

  • Orthopaedic Surgery Physician
  • Shreveport, LA
  • NPI 1295739001
  NPD (past)
• Chad E Mathis, MD

  • Orthopaedic Surgery Physician
  • Louisville, KY
  • NPI 1467444927
  NPD (past)
• Daytheon De' Ron Sturges, MPAS, PA-C

  • Physician Assistant
  • Dallas, TX
  • NPI 1184873341
  NPD (past)
• Alicia Theriot Tuttle, PA

  • Physician Assistant
  • Spartanburg, SC
  • NPI 1649422403
  NPD (past)

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

{
    "created_epoch": "1135728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339113600000",
    "number": "1306823596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 LOUISIANA AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711013910",
            "telephone_number": "318-212-8776",
            "fax_number": "318-212-8774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2751 ALBERT L BICKNELL DR",
            "address_2": "SUITE 1-B",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033920",
            "telephone_number": "318-212-8776",
            "fax_number": "318-212-8774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK NORTH ORTHOPEDIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-28",
        "last_updated": "2012-06-08",
        "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": "207XX0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447838",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• WK North Dermatology Clinic
• WK North Gynecology Clinic
• WK North Hospitalists Group
• WK North Laparoscopic Surgical Associates
• WK North Laparoscopic Surgical Associates
• WK North Pulmonary & Critical Care
• WK North Shreveport Family Medicine
• WK Northwest Internal Medicine
• WK Northwest Louisiana Infectious Disease Consultants
• WK NW Louisiana Infectious Disease Consultants

• Sports Medicine (Orthopaedic Surgery) Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2012; 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.