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NPI Code Detail

MEDICARE: WILLIS KNIGHTON MEDICAL CENTER, INC.

MEDICARE: WILLIS KNIGHTON MEDICAL CENTER, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility232LA

General Provider Information

NPI Number : 1144267451
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILLIS KNIGHTON MEDICAL CENTER, INC.
Provider Business Mailing Address
First Line : PO BOX 32600
Second Line :
City : SHREVEPORT
State : LA
Zip : 71130-2600
Country : US
Telephone Number : 318-212-8200
Fax Number : 318-212-8220
Provider Business Practice Location Address
First Line : 2550 KINGS HWY
Second Line :
City : SHREVEPORT
State : LA
Zip : 71103-3922
Country : US
Telephone Number : 318-212-8200
Fax Number : 318-212-8220
Authorized Official
Title or Position : CONTROLLER
Name : STACY H ALEXANDER
Credential :
Telephone Number : 318-212-4877
Provider Enumeration Date : 06/02/2006
Last Update Date : 08/22/2020

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