WK Red River Cardiovascular Surgeons

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

Legal business name

WK RED RIVER CARDIOVASCULAR SURGEONS

Practice address

2751 Albert L Bicknell Dr
Suite 5C
Shreveport, LA 71103-3920

Phone

(318) 227-9777

Fax

(318) 459-1188

NPI assigned

Dec 11, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Greg J. Gavin

Title

Network Administrator

Phone

(318) 212-4571

Specialties & licenses 1

Addresses

Other identifiers 1

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.

  dba WK Renal Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Shreveport, LA
  • NPI 1003020579

  Member Of

  NPD member

Locations

Practitioners 16

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.

• April Chase, ACNPC-AG

  • Acute Care Nurse Practitioner
  • Shreveport, LA
  • NPI 1437774635
  Medicare reassignment Care Compare group NPD
• Amanda Marie Davis, AGACNP-BC

  • Acute Care Nurse Practitioner
  • Shreveport, LA
  • NPI 1700401908
  Medicare reassignment Care Compare group NPD
• David P. Hamm, MD

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Shreveport, LA
  • NPI 1134182223
  Medicare reassignment Care Compare group NPD
• Syed Adil Mehmood, MD

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Shreveport, LA
  • NPI 1073723912
  Medicare reassignment Care Compare group NPD
• David H Mull, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Shreveport, LA
  • NPI 1104974641
  Medicare reassignment Care Compare group NPD
• Curtis A. Prejean Jr., MD

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Shreveport, LA
  • NPI 1790705010
  Medicare reassignment Care Compare group NPD
• Brian Keith Fontenot, PA-C

  • Medical Physician Assistant
  • Shreveport, LA
  • NPI 1790228013
  Medicare reassignment Care Compare group
• Richard Davis, PA

  • Surgical Physician Assistant
  • Lafayette, LA
  • NPI 1720536618
  Medicare reassignment
• Amy Alise Fontenot, PA-C

  • Physician Assistant
  • New Orleans, LA
  • NPI 1275011256
  Medicare reassignment
• Thea Christine Fontenot, PA-C

  • Medical Physician Assistant
  • Lake Charles, LA
  • NPI 1609474428
  Medicare reassignment
• Jeramy W Huff, PA-C

  • Medical Physician Assistant
  • Lafayette, LA
  • NPI 1821516527
  Medicare reassignment
• Tate James Perque, PA-C

  • Physician Assistant
  • Shreveport, LA
  • NPI 1003125055
  Medicare reassignment

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

{
    "created_epoch": "1228953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339113600000",
    "number": "1639314271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2551 GREENWOOD RD",
            "address_2": "SUITE 310",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033981",
            "telephone_number": "318-227-9777",
            "fax_number": "318-459-1188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2751 ALBERT L BICKNELL DR",
            "address_2": "SUITE 5C",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033920",
            "telephone_number": "318-227-9777",
            "fax_number": "318-459-1188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK RED RIVER CARDIOVASCULAR SURGEONS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-11",
        "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": "318-212-4571",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356531",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• WK Rheumatology Pierremont
• WK River Cities Interventional Pain
• WK Robotic and Laparoscopic Surgery Clinic

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Thoracic Surgery (Cardiothoracic Vascular 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.
• 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.