| Wk Haughton Medical Group | |
|
5751 Shed Rd Ste 120 Bossier City LA 71111-5662 | |
| (318) 935-1992 | |
| (318) 935-1925 |
| Full Name | Wk Haughton Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 5751 Shed Rd Ste 120, Bossier City, Louisiana |
| Authorized Official Name and Position | Greg J. Gavin (NETWORK ADMINISTRATOR) |
| Authorized Official Contact | 3186492495 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wk Haughton Medical Group 5751 Shed Rd Ste 120 Bossier City LA 71111-5662 Ph: (318) 935-1992 | Wk Haughton Medical Group 5751 Shed Rd Ste 120 Bossier City LA 71111-5662 Ph: (318) 935-1992 |
| NPI Number | 1922036763 |
|---|---|
| Provider Enumeration Date | 06/29/2006 |
| Last Update Date | 05/19/2022 |
| Medicare PECOS PAC ID | 3779682471 |
|---|---|
| Medicare Enrollment ID | O20070621000039 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922036763 | NPI | - | NPPES |
| 1107751 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Christie C Maranto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871500140 PECOS PAC ID: 2264587740 Enrollment ID: I20090904000426 |
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