| Wk Community Health Clinic | |
|
4700 Shreveport Blanchard Hwy Shreveport LA 71107-4702 | |
| (318) 221-1001 | |
| (318) 221-1044 |
| Full Name | Wk Community Health Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 4700 Shreveport Blanchard Hwy, Shreveport, Louisiana |
| Authorized Official Name and Position | Greg J Gavin (NETWORK ADMINISTRATOR) |
| Authorized Official Contact | 3182211001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wk Community Health Clinic 1202 Louisiana Ave Shreveport LA 71101-3910 Ph: (318) 221-1001 | Wk Community Health Clinic 4700 Shreveport Blanchard Hwy Shreveport LA 71107-4702 Ph: (318) 221-1001 |
| NPI Number | 1558393371 |
|---|---|
| Provider Enumeration Date | 07/06/2006 |
| Last Update Date | 06/08/2012 |
| Medicare PECOS PAC ID | 9638130065 |
|---|---|
| Medicare Enrollment ID | O20041020000188 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558393371 | NPI | - | NPPES |
| 1449539 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Tymwa Dixon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881620003 PECOS PAC ID: 5193703692 Enrollment ID: I20040712000255 |
| Provider Name | Tiffany George |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760738801 PECOS PAC ID: 9739335647 Enrollment ID: I20120808000931 |
| Provider Name | Sophia Tayebeh Shokouh-amiri |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134516578 PECOS PAC ID: 9032415286 Enrollment ID: I20190307001220 |
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