MEDICARE: D GREGORY BELL MD AND WILLIS-KNIGHTON 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
2	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

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

Provider Business Mailing Address
First Line	:	PO BOX 506
Second Line	:
City	:	COUSHATTA
State	:	LA
Zip	:	71019-0506
Country	:	US
Telephone Number	:	318-932-2170
Fax Number	:	318-932-2242

Provider Business Practice Location Address
First Line	:	1633 MARVEL ST
Second Line	:
City	:	COUSHATTA
State	:	LA
Zip	:	71019-9022
Country	:	US
Telephone Number	:	318-932-2170
Fax Number	:	318-932-2242

Authorized Official
Title or Position	:	NETWORK ADMINISTRATOR
Name	:	GREG J. GAVIN
Credential	:
Telephone Number	:	318-932-2170

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	06/08/2012

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