| Wk Neurology Clinic | |
|
2400 Hospital Dr Suite 310 Bossier City LA 71111-2385 | |
| (318) 741-2900 | |
| (318) 741-2999 |
| Full Name | Wk Neurology Clinic |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2400 Hospital Dr, Bossier City, Louisiana |
| Authorized Official Name and Position | Greg J Gavin (NETWORK ADMINISTRATOR) |
| Authorized Official Contact | 3182128780 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wk Neurology Clinic 2400 Hospital Dr Suite 310 Bossier City LA 71111-2385 Ph: (318) 741-2900 | Wk Neurology Clinic 2400 Hospital Dr Suite 310 Bossier City LA 71111-2385 Ph: (318) 741-2900 |
| NPI Number | 1336576529 |
|---|---|
| Provider Enumeration Date | 10/02/2013 |
| Last Update Date | 10/02/2013 |
| Medicare PECOS PAC ID | 2062649379 |
|---|---|
| Medicare Enrollment ID | O20131212000537 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336576529 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Sanjeevi Tivakaran |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1528199023 PECOS PAC ID: 2466532411 Enrollment ID: I20080103000663 |
| Provider Name | Sachin B Thorat |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1538333174 PECOS PAC ID: 2062664170 Enrollment ID: I20140311001090 |
| Provider Name | Mary Ann White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922413954 PECOS PAC ID: 6800018599 Enrollment ID: I20141113000675 |
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