Wk Tri-State Medical Clinic

NPI #1225082746 in Shreveport, Louisiana

Provider Information

NPI Number: 1225082746
Entity Type: Organization
Organization Name: Wk Tri-State Medical Clinic
Primary Specialty: Internal Medicine
Enumeration Date: May 20, 2006
Last Updated: Oct 5, 2012

Practice Location

Address: 2551 GREENWOOD RD
Address 2: SUITE 410
City: Shreveport
State: Louisiana
ZIP Code: 71103-3981
Phone: (318) 621-2929

Authorized Official

Name: GREG J. GAVIN
Title: NETWORK ADMINISTRATOR
Phone: (318) 212-4571

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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