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WK SIGNATURE UROLOGY CLINIC NPI 1225093610


NPI Information

NPI: 1225093610
Provider Name: WK SIGNATURE UROLOGY CLINIC
Classification: Urology - 208800000X
Entity Type: Organization

CLIA Number: 19D1053522

Address:
2551 GREENWOOD RD
SUITE 140
SHREVEPORT, LA
ZIP 71103
Phone: (318) 212-8899
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WK SIGNATURE UROLOGY CLINIC is an urology in Shreveport, LA. The provider is a urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. WK SIGNATURE UROLOGY CLINIC NPI is 1225093610. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2551 GREENWOOD RD
SUITE 140
SHREVEPORT, LA
ZIP 71103-981
Phone: (318) 212-8899
Fax: (318) 212-8806

The provider's authorized official is Greg J. Gavin .
The authorized official title is Network Administrator and has the following contact phone number (318) 212-4571.

The CLIA number assigned to this NPI record is 19D1053522 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 4/19/2006 and was last updated on 6/8/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208800000XUrologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11335223MEDICAIDLOUISIANA
25CV08MEDICARE PINLOUISIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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