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WK TRI-STATE MEDICAL CLINIC
NPI 1225082746
Internal Medicine in Shreveport, LA

Active since May 20, 2006CLIA 19D1054271 · Waiver
2551 GREENWOOD RD, SUITE 410, SHREVEPORT, LA 71103(318) 621-2929(318) 621-2930 Get Directions Write a Review

NPPES record last updated: October 5, 2012. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Wk Tri-state Medical Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WK TRI-STATE MEDICAL CLINIC (NPI 1225082746) is a healthcare organization registered as an internal medicine in Shreveport, Louisiana and active in the NPI registry since May 2006. The organization holds a CLIA Waiver certificate valid through May 15, 2028 and lists Greg J. Gavin, Network Administrator, as its authorized official.

NPPES Registry Identity

NPI1225082746
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameWK TRI-STATE MEDICAL CLINIC
Location Address2551 GREENWOOD RD, SUITE 410Shreveport, LA 71103-3981
Mailing Address2551 Greenwood Rd, Suite 410Shreveport, LA 71103-3981 · (318) 621-2929 · Fax (318) 621-2930
Phone(318) 621-2929
Fax(318) 621-2930
Organization SubpartNo
Authorized OfficialGreg J. GavinNetwork Administrator · (318) 212-4571
Enumeration DateMay 20, 2006
Last NPPES UpdateOctober 5, 2012
✔ NPI 1225082746 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
2551 GREENWOOD RD, Shreveport, LA 71103
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Other Identifiers 2

Medicare PIN5CU97LA
Medicaid1448419LA

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 19D1054271

Wk Tri State Medical Clinic · Shreveport, LA
Active · expires May 15, 2028
CLIA Number19D1054271
Laboratory TypePhysician Office
Certificate Effective DateMay 16, 2026
Certificate Expiration DateMay 15, 2028
Laboratory DirectorAnthony T. Stuart
Laboratory Phone(318) 621-2929
Laboratory LocationWk Tri State Medical Clinic2551 Greenwood Road Suite 410, Shreveport, LA 71103
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANDREW DENTINO MD AND WILLIS-KNIGHTON MEDICAL CENTER
Internal Medicine
2551 GREENWOOD RD, SUITE 310
SHREVEPORT, LA 71103
Caddo Parish (318) 212-8780
RAYMOND A. COGHLAN MD AND WILLIS-KNIGHTON MEDICAL CENTER
Internal Medicine (Infectious Disease)
2551 GREENWOOD RD, SUITE 150
SHREVEPORT, LA 71103
Caddo Parish (318) 631-9996
CALEB HARKINS APRN, AGACNP
Nurse Practitioner (Acute Care)
2551 GREENWOOD RD, SUITE #210
SHREVEPORT, LA 71103
Caddo Parish (318) 635-0834
VIJOYDEEP RAO MD & WILLIS-KNIGHTON MEDICAL CENTER
Internal Medicine
2551 GREENWOOD RD, SUITE 310
SHREVEPORT, LA 71103
Caddo Parish (318) 212-8780
JAMES G. HOWELL MD AND WILLIS-KNIGHTON MEDICAL CENTER
Surgery
2551 GREENWOOD RD, SUITE 310
SHREVEPORT, LA 71103
Caddo Parish (318) 212-8780
PIERRE VALMONT BLANCHARD MD
Internal Medicine
2551 GREENWOOD RD, SUITE 410
SHREVEPORT, LA 71103
Caddo Parish (318) 621-2929
AMBROSIA T. HOLSAPPLE NP
Nurse Practitioner
2551 GREENWOOD RD, SUITE 410
SHREVEPORT, LA 71103
Caddo Parish (318) 621-2929
MR. CLAY JONES R.PH
Pharmacist
2551 GREENWOOD RD, SUITE 110
SHREVEPORT, LA 71103
Caddo Parish (318) 631-2005

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Wk Tri-State Medical Clinic's NPI number?

The NPI number for Wk Tri-State Medical Clinic is 1225082746. It was assigned to this organization in the NPPES registry on May 20, 2006.

Where is Wk Tri-State Medical Clinic located?

Wk Tri-State Medical Clinic is located at 2551 Greenwood Rd Suite 410, Shreveport, LA 71103. The listed phone number is (318) 621-2929.

What is Wk Tri-State Medical Clinic's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Wk Tri-State Medical Clinic hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 19D1054271) is associated with this NPI, valid through May 15, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Wk Tri-State Medical Clinic accept?

Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health, Ambetter from Superior HealthPlan and Blue Cross and Blue Shield of Louisiana and 1 other insurer list Wk Tri-State Medical Clinic as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Wk Tri-State Medical Clinic was last updated on October 5, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.