Provider Demographics
NPI:1891083457
Name:WK URGENT CARE CENTER-SOUTH
Entity Type:Organization
Organization Name:WK URGENT CARE CENTER-SOUTH
Other - Org Name:QUICK CARE SOUTH
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-212-8785
Mailing Address - Street 1:2520 BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3130
Mailing Address - Country:US
Mailing Address - Phone:318-212-5520
Mailing Address - Fax:318-212-5540
Practice Address - Street 1:2520 BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:SUITE 105
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3130
Practice Address - Country:US
Practice Address - Phone:318-212-5520
Practice Address - Fax:318-212-5540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017191207Q00000X
LA023750207Q00000X
LA022420207Q00000X
LA200321207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty