Organization
WK BOSSIER RIVER CITIES INTERVENTIONAL PAIN SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization
Contact information
Practice address
2449 HOSPITAL DR, SUITE 300, BOSSIER CITY, LA 71111-2399
(318) 212-7960
(318) 212-7965
Mailing address
2449 HOSPITAL DR, SUITE 300, BOSSIER CITY, LA 71111-2399
(318) 212-7960
(318) 212-7965
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1803537
—
LA
Enumeration date
10/02/2009
Last updated
06/08/2012
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