Provider Demographics
NPI:1740057488
Name:WK NEUROVASCULAR NEUROSURGERY
Entity type:Organization
Organization Name:WK NEUROVASCULAR NEUROSURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. VP OF 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 1:2727 HEARNE AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3917
Mailing Address - Country:US
Mailing Address - Phone:318-212-6797
Mailing Address - Fax:318-212-6822
Practice Address - Street 1:2727 HEARNE AVE STE 320
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3917
Practice Address - Country:US
Practice Address - Phone:318-212-6797
Practice Address - Fax:318-212-6822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty