Healthcare Provider Details

I. General information

NPI: 1801831169
Provider Name (Legal Business Name): D GREGORY BELL MD AND WILLIS-KNIGHTON MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 06/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 MARVEL ST
COUSHATTA LA
71019-9022
US

IV. Provider business mailing address

PO BOX 506
COUSHATTA LA
71019-0506
US

V. Phone/Fax

Practice location:
  • Phone: 318-932-2170
  • Fax: 318-932-2242
Mailing address:
  • Phone: 318-932-2170
  • Fax: 318-932-2242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GREG J. GAVIN
Title or Position: NETWORK ADMINISTRATOR
Credential:
Phone: 318-932-2170