Provider Demographics
NPI:1922533637
Name:WK ALLERGY ASTHMA & IMMUNOLOGY CENTER
Entity Type:Organization
Organization Name:WK ALLERGY ASTHMA & IMMUNOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-716-4937
Mailing Address - Street 1:2530 BERT KOUNS INDUSTRIAL LOOP STE 112
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3153
Mailing Address - Country:US
Mailing Address - Phone:318-212-8780
Mailing Address - Fax:318-212-5994
Practice Address - Street 1:2530 BERT KOUNS INDUSTRIAL LOOP STE 112
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3153
Practice Address - Country:US
Practice Address - Phone:318-212-8780
Practice Address - Fax:318-212-5994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty