WK Center for Pediatric Gastroenterology

Primary specialty

Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X

Legal business name

WK CENTER FOR PEDIATRIC GASTROENTEROLOGY

Practice address

WK Center for Pediatric Gastroenterology
2530 Bert Kouns Industrial Loop, Ste 113
Shreveport, LA 71118

Phone

(318) 212-5811

Fax

(318) 212-5844

NPI assigned

Oct 11, 2019

Organization subpart

No

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

Authorized official

Name

Mary Jane Ward

Title

Senior VP Finance

Phone

(318) 212-8951

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 9

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

• Charles Godfried Otu-Nyarko, M.D

  • Pediatric Gastroenterology Physician
  • Shreveport, LA
  • NPI 1245487404
  Medicare reassignment NPD
• Sacha Patel, FNP-C

  • Family Nurse Practitioner
  • Shreveport, LA
  • NPI 1265114136
  Medicare reassignment NPD
• Jennifer Tupper, APRN

  • Pediatric Nurse Practitioner
  • Shreveport, LA
  • NPI 1437711876
  Medicare reassignment NPD
• Victor Essien Uko, M.D.

  • Pediatric Gastroenterology Physician
  • Shreveport, LA
  • NPI 1639348832
  Medicare reassignment NPD
• Virginia Homza Carter

  • Pediatrics Physician
  • Shreveport, LA
  • NPI 1598077323
  NPD (past)
• Marleen Jannett Combs, FNP

  • Family Nurse Practitioner
  • Shreveport, LA
  • NPI 1720556855
  NPD (past)
• Sunny Zaheed Hussain, MD

  • Pediatric Gastroenterology Physician
  • Shreveport, LA
  • NPI 1730155581
  NPD (past)
• Manohar R. Manchandia, MD

  • Pediatrics Physician
  • Bossier City, LA
  • NPI 1023086873
  NPD (past)
• Tamara Lynn Moore, M.D.

  • Pediatrics Physician
  • Shreveport, LA
  • NPI 1497011001
  NPD (past)

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

{
    "created_epoch": "1570752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570752000000",
    "number": "1720620784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "WK CENTER FOR PEDIATRIC GASTROENTEROLOGY",
            "address_2": "2530 BERT KOUNS INDUSTRIAL LOOP, STE 113",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71118",
            "telephone_number": "318-212-5811",
            "fax_number": "318-212-5844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "WK CENTER FOR PEDIATRIC GASTROENTEROLOGY",
            "address_2": "2530 BERT KOUNS INDUSTRIAL LOOP, STE 113",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71118",
            "telephone_number": "318-212-5811",
            "fax_number": "318-212-5844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK CENTER FOR PEDIATRIC GASTROENTEROLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-11",
        "last_updated": "2019-10-11",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "MARY JANE",
        "authorized_official_title_or_position": "SENIOR VP FINANCE",
        "authorized_official_telephone_number": "318-212-8951"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• WK Behavioral Health Services
• WK Breast Health & Surgical Center
• WK Care for Kids Clinic
• WK Center for Endocrinology and Diabetes
• WK Center for Neurosurgery at Pierremont
• WK Center for Pediatrics - South
• WK Center for Psychiatric Support
• WK Center for Womens Health and Wellness
• WK Child Neurology
• WK Childrens Health Specialists

• Pediatric Gastroenterology Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Pediatric Gastroenterology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2019; 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.