WK South Shreveport Family Practice

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WK SOUTH SHREVEPORT FAMILY PRACTICE

Practice address

2520 Bert Kouns Loop Ste 102
Shreveport, LA 71118-3130

Phone

(318) 212-5972

Fax

(318) 212-5369

NPI assigned

Jan 14, 2008

Last updated

Jun 8, 2012By 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

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

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

{
    "created_epoch": "1200268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339113600000",
    "number": "1346426913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2520 BERT KOUNS LOOP STE 102",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183130",
            "telephone_number": "318-212-5972",
            "fax_number": "318-212-5369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2520 BERT KOUNS LOOP STE 102",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183130",
            "telephone_number": "318-212-5972",
            "fax_number": "318-212-5369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK SOUTH SHREVEPORT FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-14",
        "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": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• WK South Audiology Center
• WK South Hospitalists
• WK South OB-GYN Clinic
• WK South Orthopedic Clinic
• WK South Shreveport Behavioral Health
• WK South Shreveport Womens Health Clinic
• WK South Surgical Hospitalists
• WK Spectrum Neurosurgery-the Brain & Spine Specialist
• WK Spine Clinic
• WK Spine Institute

• Family Medicine Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Family Medicine 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.