WK Butler-Abshire Medical Clinic

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

WK BUTLER-ABSHIRE MEDICAL CLINIC

Practice address

926 Frances Dr
Haynesville, LA 71038-6100

Phone

(318) 624-0554

Fax

(318) 624-3782

NPI assigned

Jul 6, 2006

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) 624-0554

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.

  dba WK Extended Care Center

  • Skilled Nursing Facility
  • Shreveport, LA
  • NPI 1144267451

  Member Of

  NPD member

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219017600000",
    "number": "1407888209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 271",
            "city": "HAYNESVILLE",
            "state": "LA",
            "postal_code": "710380271",
            "telephone_number": "318-624-0554",
            "fax_number": "318-624-3782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "926 FRANCES DR",
            "city": "HAYNESVILLE",
            "state": "LA",
            "postal_code": "710386100",
            "telephone_number": "318-624-0554",
            "fax_number": "318-624-3782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK BUTLER-ABSHIRE MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2008-08-18",
        "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": "318-624-0554"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1944327",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136859729",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ted S Pharmacy LLC (Ted's Pharmacy)
• Ted's Pharmacy
• Tri-State Health Services of Cenla, LLC (Heritage Nursing Center)
• Dan Thomas Ware, RPH
• Bethany Willis, IBCLC

• Rural Health Clinic/Center in Haynesville, LA
• Providers in Haynesville, LA by specialty
• Rural Health Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2008; 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.