| Wk Pierre Ave Community Health Education And Wellness Center | |
|
1327 Pierre Ave Shreveport LA 71103-3056 | |
| (318) 212-8624 | |
| (318) 226-8545 |
| Full Name | Wk Pierre Ave Community Health Education And Wellness Center |
|---|---|
| Speciality | Family Medicine |
| Location | 1327 Pierre Ave, Shreveport, Louisiana |
| Authorized Official Name and Position | Greg J Gavin (NETWORK ADMINISTRATOR) |
| Authorized Official Contact | 3182128624 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wk Pierre Ave Community Health Education And Wellness Center 1327 Pierre Ave Shreveport LA 71103-3056 Ph: (318) 212-8624 | Wk Pierre Ave Community Health Education And Wellness Center 1327 Pierre Ave Shreveport LA 71103-3056 Ph: (318) 212-8624 |
| NPI Number | 1881626513 |
|---|---|
| Provider Enumeration Date | 07/06/2006 |
| Last Update Date | 05/14/2014 |
| Medicare PECOS PAC ID | 5597743906 |
|---|---|
| Medicare Enrollment ID | O20040712001183 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881626513 | NPI | - | NPPES |
| 1447188 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 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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