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General NPI Number Information
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NPI Number | 1487693149
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Entity Type | Organization
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Legal Business Name | WILLIS KNIGHTON MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 07/25/2008
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Provider Practice Location Address
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Address Line | 3300 ALBERT L BICKNELL DR SUITE 3
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City | SHREVEPORT
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State | LA
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Zip | 71103-3903
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Country | US
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Telephone | 318-212-4697
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Fax | 318-212-8377
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Provider Business Mailing Address
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Address Line | 3300 ALBERT L BICKNELL DR SUITE 3
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City | SHREVEPORT
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State | LA
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Zip | 71103-3903
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Country | US
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Telephone | 318-212-4697
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Fax | 318-212-8377
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | MR. ROBERT D HUIE
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Credential |
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Telephone | 318-212-4448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 17
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License Number State | LA
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