Organization
WK PLAIN DEALING MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J GAVIN (NETWORK ADMINISTRATOR)
(318) 326-7272
Entity
Organization
Contact information
Practice address
108 N LOUISIANA ST, PLAIN DEALING, LA 71064-3446
(318) 326-7272
(318) 326-7282
Mailing address
PO BOX 3038, SHREVEPORT, LA 71133-3038
(318) 212-8946
(318) 212-4025
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1948306
—
LA
Enumeration date
07/06/2006
Last updated
01/02/2009
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