# WK ORTHOPEDIC SPECIALTY CENTER

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

## Provider details

- **NPI number:** 1255624169
- **Authorized official:** GREG J GAVIN (NETWORK ADMINSTRATOR)
- **Authorized official phone:** (318) 212-4232

## Contact information

- **Practice address:** 2551 GREENWOOD RD STE 130, SHREVEPORT, LA 71103-3984
- **Practice address phone:** (318) 212-8681
- **Practice address fax:** (318) 212-8685
- **Mailing address:** 2551 GREENWOOD RD STE 130, SHREVEPORT, LA 71103-3984
- **Mailing address phone:** (318) 212-8681
- **Mailing address fax:** (318) 212-8685

## Taxonomy

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

## Other

- **Enumeration date:** 05/25/2011
- **Last updated:** 06/08/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2169939 | — | LA |