Active NPI
Willis-Knighton Medical Center, Inc
Doing business as WK Tristate Neurology Clinic
- Neurology Physician
- Shreveport, LA
National Provider Identifier
1700165891
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- Legal business name
- WILLIS-KNIGHTON MEDICAL CENTER, INC
- Doing business as
- WK Tristate Neurology Clinic
- Practice address
- 2551 Greenwood Rd
Suite 240
Shreveport, LA 71103-3981 - Phone
- (318) 212-8675
- Fax
- (318) 212-8680
- NPI assigned
- Aug 8, 2011
- Last updated
- Nov 23, 2011
- Organization subpart
- Yes
- Parent organization
- WILLIS-KNIGHTON MEDICAL CENTER, INC.
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | Primary |
Addresses
Primary practice location
2551 Greenwood Rd
Suite 240
Shreveport, LA 71103-3981
Mailing address
2551 Greenwood Rd
Suite 240
Shreveport, LA 71103-3981
Phone (318) 212-8675
Other names 1
- WK Tristate Neurology Clinic
National Provider Directory
National Provider Directory- Part of
- Willis Knighton Pierrem
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312761600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1322006400000",
"number": "1700165891",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2551 GREENWOOD RD",
"address_2": "SUITE 240",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711033981",
"telephone_number": "318-212-8675",
"fax_number": "318-212-8680"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2551 GREENWOOD RD",
"address_2": "SUITE 240",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711033981",
"telephone_number": "318-212-8675",
"fax_number": "318-212-8680"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WILLIS-KNIGHTON MEDICAL CENTER, INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "WILLIS-KNIGHTON MEDICAL CENTER, INC.",
"enumeration_date": "2011-08-08",
"last_updated": "2011-11-23",
"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": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "WK Tristate Neurology Clinic",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Shreveport, LA
- Willis Knighton Medical Center, Inc. (Willis Knighton Behavioral Medicine Unit)
- Willis Knighton Medical Center, Inc. WK Emergency Dept Group
- Willis Knighton Work Kare (WK Work Kare)
- Willis-Knighton Medical Center & Johnston Johnny MD
- Willis-Knighton Medical Center Michelle Self MD
- Willis-Knighton Medical Center, Inc. (WK Regional Orthopedic and Sports Medicine)
- Willis-Knighton Medical Center, Inc. (Jeffery Foss MD and Willis-Knighton Medical Center)
- Willis-Knighton Medical Center, Inc. (A WK Clinic for Women - South)
- Willis-Knighton Medical System
- Brandy Willis
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.