WK Pierre Ave Community Health Education and Wellness Center

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WK PIERRE AVE COMMUNITY HEALTH EDUCATION AND WELLNESS CENTER

Practice address

1327 Pierre Ave
Shreveport, LA 71103-3056

Phone

(318) 212-8624

Fax

(318) 226-8545

NPI assigned

Jul 6, 2006

Last updated

May 14, 2014By 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) 212-8624

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.

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

  Member Of

  NPD member

Practitioners 2

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.

• Tymwa Duval Dixon, MD

  • Family Medicine Physician
  • Shreveport, LA
  • NPI 1881620003
  Medicare reassignment Care Compare group NPD
• Sophia Tayebeh Shokouh-Amiri, MD

  • Family Medicine Physician
  • Shreveport, LA
  • NPI 1134516578
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400025600000",
    "number": "1881626513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1327 PIERRE AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033056",
            "telephone_number": "318-212-8624",
            "fax_number": "318-226-8545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1327 PIERRE AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033056",
            "telephone_number": "318-212-8624",
            "fax_number": "318-226-8545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK PIERRE AVE COMMUNITY HEALTH EDUCATION AND WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2014-05-14",
        "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": "318-212-8624"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447188",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• WK Pediatric Intensivist
• WK Pediatric Pulmonology Specialists
• WK Pediatric Surgical Associates
• WK Pelvic & Reconstructive Surgery
• WK Physicians Network
• WK Pierremont Associates in Internal Medicine
• WK Pierremont Cardiology
• WK Pierremont Endocrine Center
• WK Pierremont ENT
• WK Pierremont Eye Institute

• 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 May 14, 2014; 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.