Provider Demographics
NPI:1679351795
Name:WK RUSTON PEDIATRICS
Entity Type:Organization
Organization Name:WK RUSTON PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. VP 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 1:931 N TRENTON ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-3327
Mailing Address - Country:US
Mailing Address - Phone:318-497-7750
Mailing Address - Fax:318-467-7757
Practice Address - Street 1:931 N TRENTON ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-3327
Practice Address - Country:US
Practice Address - Phone:318-497-7750
Practice Address - Fax:318-467-7757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty