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General NPI Number Information
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NPI Number | 1497277677
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Entity Type | Organization
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Legal Business Name | WK SPECTRUM NEUROSURGERY-THE BRAIN & SPINE SPECIALIST
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Dates
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Enumeration Date | 07/10/2017
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Last Update Date | 06/13/2023
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Provider Practice Location Address
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Address Line | 2751 ALBERT L BICKNELL DR STE 1A
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City | SHREVEPORT
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State | LA
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Zip | 71103-3943
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Country | US
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Telephone | 318-212-8115
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Fax | 318-212-8124
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Provider Business Mailing Address
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Address Line | 2751 ALBERT L BICKNELL DR STE 1A
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City | SHREVEPORT
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State | LA
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Zip | 71103-3943
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Country | US
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Telephone | 318-212-8115
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Fax | 318-212-8124
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Authorized Official
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Title or Position | SR. VICE PRESIDENT FINANCE
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Name | MARY JANE WARD
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Credential |
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Telephone | 318-716-4939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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