WK Pediatric Pulmonology Specialists

Primary specialty

Pediatric Pulmonology PhysicianTaxonomy code 2080P0214X

Legal business name

WK PEDIATRIC PULMONOLOGY SPECIALISTS

Practice address

2530 Bert Koun Loop
Suite 114
Shreveport, LA 71118-3132

Phone

(318) 212-5781

Fax

(318) 212-5785

NPI assigned

Aug 27, 2015

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) 212-5780

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 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

Locations

Practitioners 1

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

• Kimberly Lynn Jones, M.D.

  • Pediatric Pulmonology Physician
  • Shreveport, LA
  • NPI 1235159112

  LA, Pediatric Pulmonology

  Medicare reassignment NPD

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

{
    "created_epoch": "1440633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440633600000",
    "number": "1376910240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2530 BERT KOUN LOOP",
            "address_2": "SUITE 114",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183132",
            "telephone_number": "318-212-5781",
            "fax_number": "318-212-5785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 BERT KOUN LOOP",
            "address_2": "SUITE 114",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183132",
            "telephone_number": "318-212-5781",
            "fax_number": "318-212-5785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK PEDIATRIC PULMONOLOGY SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-27",
        "last_updated": "2015-08-27",
        "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": "318-212-5780"
    },
    "taxonomies": [
        {
            "code": "2080P0214X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• WK Pediatric Eye Specialists
• WK Pediatric Gi Specialists
• WK Pediatric Health & Wellness
• WK Pediatric Healthcare Associates
• WK Pediatric Intensivist
• WK Pediatric Surgical Associates
• WK Pelvic & Reconstructive Surgery
• WK Physicians Network
• WK Pierre Ave Community Health Education and Wellness Center
• WK Pierremont Associates in Internal Medicine

• All providers in Shreveport, LA
• Pediatric Pulmonology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 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.