Provider Demographics
NPI:1851918486
Name:WK BOSSIER ENT & ALLERGY INSTITUTE
Entity Type:Organization
Organization Name:WK BOSSIER ENT & ALLERGY INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-212-8299
Mailing Address - Street 1:2449 HOSPITAL DR STE 440
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-1918
Mailing Address - Country:US
Mailing Address - Phone:318-212-7288
Mailing Address - Fax:318-212-7295
Practice Address - Street 1:2449 HOSPITAL DR STE 440
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-1918
Practice Address - Country:US
Practice Address - Phone:318-212-7288
Practice Address - Fax:318-212-7295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty