NPIMap

Organization Active NPI

WK Spine & Pain Specialists

  • Interventional Pain Medicine Physician
  • Bossier City, LA
National Provider Identifier
1982065645
Registry record updated Mar 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
MD.199995 Issued in LA
Legal business name
WK SPINE & PAIN SPECIALISTS
Practice address
2449 Hospital Dr
Suite 300
Bossier City, LA 71111-2399
Phone
(318) 212-7960
Fax
(318) 212-7965
NPI assigned
Mar 9, 2016
Last updated
Mar 9, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2016

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

Authorized official

Name
Mr. Greg J Gavin
Title
Administrator
Phone
(318) 212-8951

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine Physician 208VP0014X MD.199995 LA Primary

Addresses

Primary practice location

2449 Hospital Dr
Suite 300
Bossier City, LA 71111-2399

Mailing address

2449 Hospital Dr
Suite 300
Bossier City, LA 71111-2399
Phone (318) 212-7960

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160506001862 LA Part B Supplier - Clinic/Group Practice 0547569840 Receives reassigned benefits from 14 practitioners
Practice locations: Bossier City, LA; Shreveport, LA

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2449 Hospital Dr
Ste 300
Bossier City, LA 71111
Phone (318) 212-3636

1811 E Bert Kouns Industrial Loop
Ste 300
Shreveport, LA 71105
Phone (318) 212-3636

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1457481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457481600000",
    "number": "1982065645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2449 HOSPITAL DR",
            "address_2": "SUITE 300",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112399",
            "telephone_number": "318-212-7960",
            "fax_number": "318-212-7965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2449 HOSPITAL DR",
            "address_2": "SUITE 300",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112399",
            "telephone_number": "318-212-7960",
            "fax_number": "318-212-7965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK SPINE & PAIN SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-09",
        "last_updated": "2016-03-09",
        "status": "A",
        "authorized_official_last_name": "GAVIN",
        "authorized_official_first_name": "GREG",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "318-212-8951",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "LA",
            "license": "MD.199995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bossier City, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2016; 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.