WK Spine & Pain Specialists
Organization Active NPI Interventional Pain Medicine Physician · Bossier City, LA
NPI 1982065645 · NPPES record last updated Mar 9, 2016
Key facts
- NPI
- 1982065645
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Interventional Pain Medicine Physician 208VP0014X
- License
- MD.199995 (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
- Organization subpart
- No
Authorized official
- Name
- Mr. Greg J Gavin
- Title
- Administrator
- Phone
- (318) 212-8951
Member of 1
Practitioners 19
-
John G Noles, M.D.
-
Russell T Stuermann, M.D.
-
Sarah Carson Brantley, P.A.
-
Tyra Brown, PA-C
-
Hillary Davis, PA
-
Emily K. Leblanc, PA
-
Bridget Whittington, PA-C
-
Jordan Cage Wyatt, PA-C
-
Carmen R. Schaumburg, PA-C
-
Jefferey D Adair, MD
-
Rebecca A. Posner, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
Locations
1811 E Bert Kouns Industrial Loop
Shreveport, LA 71105
Phone (318) 424-8373
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Interventional Pain Medicine Physician |
208VP0014X | MD.199995 | LA | Yes |
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
Other providers in Bossier City, LA
- WK North Bossier ENT
- WK Precision Neurosurgery
- WK Preferred Pediatrics
- WK Premier Pediatrics
- WK Red River Internal Medicine
- WK Swan Lake Diabetes & Endocrinology
- WK Urgent Care Center - Bossier
- WK Womens Health Associates
- WK Zaffater Eye Center
- WKB Family Medicine Associates
All providers in Bossier City, LA · Interventional Pain Medicine Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.