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WK TOTS TO TEENS PEDIATRIC CENTER NPI 1063769255


NPI Information

NPI: 1063769255
Provider Name: WK TOTS TO TEENS PEDIATRIC CENTER
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 19D2045789

Address:
845 OLIVE ST
SUITE A
SHREVEPORT, LA
ZIP 71104
Phone: (318) 226-4892
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WK TOTS TO TEENS PEDIATRIC CENTER is a pediatrics in Shreveport, LA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. WK TOTS TO TEENS PEDIATRIC CENTER NPI is 1063769255. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

845 OLIVE ST
SUITE A
SHREVEPORT, LA
ZIP 71104-141
Phone: (318) 226-4892
Fax: (318) 227-4927

The provider's authorized official is Greg J Gavin .
The authorized official title is Network Administrator and has the following contact phone number (318) 212-4232.

The CLIA number assigned to this NPI record is 19D2045789 - physician office with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 8/7/2012 and was last updated on 8/7/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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