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General NPI Number Information
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NPI Number | 1235523002
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Entity Type | Organization
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Legal Business Name | WK PIERREMONT CARDIOLOGY
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Dates
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Enumeration Date | 03/19/2015
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 1811 E BERT KOUN LOOP SUITE 210
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City | SHREVEPORT
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State | LA
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Zip | 71105-5740
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Country | US
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Telephone | 318-212-8780
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Fax | 318-212-6752
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Provider Business Mailing Address
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Address Line | 1811 E BERT KOUN LOOP SUITE 210
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City | SHREVEPORT
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State | LA
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Zip | 71105-5740
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Country | US
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Telephone | 318-212-8780
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Fax | 318-212-6752
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Authorized Official
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Title or Position | NETWORK ADMINISTRATOR
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Name | GREG J GAVIN
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Credential |
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Telephone | 318-212-8780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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