Basic Information
| Provider Information | |||||||||
| NPI: | 1922533637 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WK ALLERGY ASTHMA & IMMUNOLOGY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2530 BERT KOUNS INDUSTRIAL LOOP STE 112 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711183153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182128780 | ||||||||
| FaxNumber: | 3182125994 | ||||||||
| Practice Location | |||||||||
| Address1: | 2530 BERT KOUNS INDUSTRIAL LOOP STE 112 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711183153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182128780 | ||||||||
| FaxNumber: | 3182125994 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2017 | ||||||||
| LastUpdateDate: | 10/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | WARD | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR VP OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 3187164937 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology |
No ID Information.