Provider Demographics
NPI:1497277677
Name:WK SPECTRUM NEUROSURGERY-THE BRAIN & SPINE SPECIALIST
Entity Type:Organization
Organization Name:WK SPECTRUM NEUROSURGERY-THE BRAIN & SPINE SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. VICE PRESIDENT FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-716-4939
Mailing Address - Street 1:2751 ALBERT L BICKNELL DR STE 1A
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3943
Mailing Address - Country:US
Mailing Address - Phone:318-212-8115
Mailing Address - Fax:318-212-8124
Practice Address - Street 1:2751 ALBERT L BICKNELL DR STE 1A
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3943
Practice Address - Country:US
Practice Address - Phone:318-212-8115
Practice Address - Fax:318-212-8124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-10
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty