Organization
WK SHREVEPORT CENTER FOR GERIATRIC HEALTH
Active
Organization
WK SHREVEPORT CENTER FOR GERIATRIC HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization
Contact information
Practice address
2508 BERT KOUNS LOOP, SUITE 303, SHREVEPORT, LA 71118-3133
(318) 212-5850
(318) 212-5855
Mailing address
2508 BERT KOUNS LOOP, SUITE 303, SHREVEPORT, LA 71118-3133
(318) 212-5850
(318) 212-5855
Taxonomy
Speciality
Code
Description
License number
State
2084P0805X
Geriatric Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1818798
—
LA
01
—
5DL73
MEDICARE PTAN
LA
Enumeration date
12/16/2009
Last updated
01/23/2014
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up