Organization
WK TRI-STATE MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4571
Entity
Organization
Contact information
Practice address
2551 GREENWOOD RD, SUITE 410, SHREVEPORT, LA 71103-3981
(318) 621-2929
(318) 621-2930
Mailing address
2551 GREENWOOD RD, SUITE 410, SHREVEPORT, LA 71103-3981
(318) 621-2929
(318) 621-2930
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1448419
—
LA
Enumeration date
05/20/2006
Last updated
10/05/2012
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us