Organization
WK COMMUNITY HEALTH CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J GAVIN (NETWORK ADMINISTRATOR)
(318) 221-1001
Entity
Organization
Contact information
Practice address
4700 SHREVEPORT BLANCHARD HWY, SHREVEPORT, LA 71107-4702
(318) 221-1001
(318) 221-1044
Mailing address
1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
(318) 221-1001
(318) 221-1044
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1449539
—
LA
Enumeration date
07/06/2006
Last updated
06/08/2012
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