| Organization Name: | WK PEDIATRIC INTENSIVIST |
| NPI Number: | 1023074549 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GREG J. GAVIN (NETWORK ADMINISTRATOR) |
| Mailing Address: | 8001 Youree Dr Room 2221 Shreveport |
| State: | LA US |
| Postal Code: | 711152302 |
| Phone Number: | 3182123868 |
| Fax Number: | 3182123099 |
| NPI Enumeration Date: | 04/24/2006 |
| NPI Last Update Date: | 06/12/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2080P0203X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Pediatrics |
| Taxonomy Specialization: | Pediatric Critical Care Medicine |
| Taxonomy Definition: | A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists. |