# WK SHREVEPORT INTERNAL MEDICINE

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

## Provider details

- **NPI number:** 1255018388
- **Authorized official:** MARY JANE WARD (SENIOR VP FINANCE)
- **Authorized official phone:** (318) 716-4939

## Contact information

- **Practice address:** 1449 E BERT KOUNS INDUSTRIAL LOOP STE 100, SHREVEPORT, LA 71105-5680
- **Practice address phone:** (318) 629-0220
- **Practice address fax:** (318) 629-0230
- **Mailing address:** 1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
- **Mailing address phone:** (318) 716-4939
- **Mailing address fax:** (318) 716-4854

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/30/2023
- **Last updated:** 06/30/2023