# WK AND BONE & JOINT CLINIC - BOSSIER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205887981
- **Authorized official:** GREG J. GAVIN (NETWORK ADMINISTRATOR)
- **Authorized official phone:** (318) 212-8701

## Contact information

- **Practice address:** 2449 HOSPITAL DR, SUITE 200, BOSSIER CITY, LA 71111-2399
- **Practice address phone:** (318) 425-8701
- **Practice address fax:** (318) 424-0376
- **Mailing address:** 2449 HOSPITAL DR, SUITE 200, BOSSIER CITY, LA 71111-2382
- **Mailing address phone:** (318) 425-8701
- **Mailing address fax:** (318) 424-0376

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/15/2006
- **Last updated:** 06/08/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 14924851 | — | LA |
| 01 | — | 614325700 | US DEPT OF LABOR | — |