WK North Shreveport Family Medicine

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WK NORTH SHREVEPORT FAMILY MEDICINE

Practice address

3312 N Market St
Shreveport, LA 71107-4009

Phone

(318) 222-5270

Fax

(318) 221-4559

NPI assigned

Jun 19, 2006

Last updated

Jun 8, 2012By the provider in NPPES

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) 222-5270

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.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1568461572

  Member Of

  NPD member

Locations

Practitioners 4

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.

• Bruce P. Brouillette, MD

  • Family Medicine Physician
  • Shreveport, LA
  • NPI 1194753913
  Medicare reassignment Care Compare group NPD
• David W. Hudson, MD

  • Family Medicine Physician
  • Shreveport, LA
  • NPI 1558390021
  Medicare reassignment Care Compare group NPD
• Molly Henderson Maranto, PA-C

  • Physician Assistant
  • Bossier City, LA
  • NPI 1497788517
  Medicare reassignment Care Compare group
• Mitchell F Horan, MD

  • Family Medicine Physician
  • Dillingham, AK
  • NPI 1952388449
  NPD (past)

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339113600000",
    "number": "1811932197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3312 N MARKET ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711074009",
            "telephone_number": "318-222-5270",
            "fax_number": "318-221-4559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3312 N MARKET ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711074009",
            "telephone_number": "318-222-5270",
            "fax_number": "318-221-4559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK NORTH SHREVEPORT FAMILY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "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": "318-222-5270"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• WK North Hospitalists Group
• WK North Laparoscopic Surgical Associates
• WK North Laparoscopic Surgical Associates
• WK North Orthopedic Clinic
• WK North Pulmonary & Critical Care
• WK Northwest Internal Medicine (Willis Knighton Internal Medicine Pierremont Suite 550)
• WK Northwest Louisiana Infectious Disease Consultants
• WK NW Louisiana Infectious Disease Consultants
• WK OB-GYN Associates of Shreveport
• WK OB-GYN Concepts

• Family Medicine Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Family Medicine 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.