MEDICARE: NANCY GERMANY MD AND WILLIS-MEDICAL CENTER

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
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1205862877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NANCY GERMANY MD AND WILLIS-MEDICAL CENTER

Provider Business Mailing Address
First Line	:	6821 PINES RD
Second Line	:	SUITE 100
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-2547
Country	:	US
Telephone Number	:	318-687-5500
Fax Number	:	318-687-5503

Provider Business Practice Location Address
First Line	:	6821 PINES RD
Second Line	:	SUITE 100
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-2547
Country	:	US
Telephone Number	:	318-687-5500
Fax Number	:	318-687-5503

Authorized Official
Title or Position	:	NETWORK ADMINISTRATOR
Name	:	GREG J. GAVIN
Credential	:
Telephone Number	:	318-687-5500

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	08/05/2009

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