Organization
WK BOSSIER PULMONARY & CRITICAL CARE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization
Contact information
Practice address
2400 HOSPITAL DR, SUITE 340, BOSSIER CITY, LA 71111-2385
(318) 747-2277
(318) 747-2217
Mailing address
2400 HOSPITAL DR, SUITE 340, BOSSIER CITY, LA 71111-2385
(318) 747-2277
(318) 747-2217
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063487
—
LA
Enumeration date
05/03/2007
Last updated
12/19/2016
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