Basic Information
| Provider Information | |||||||||
| NPI: | 1710039896 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLIS KNIGHTON MEDICAL CENTER, INC. | ||||||||
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| OtherOrganizationName: | WILLIS KNIGHTON REHABILITATION UNIT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 32600 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711302600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182124000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1111 LINE AVENUE | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182124877 | ||||||||
| FaxNumber: | 3182124192 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 02/17/2017 | ||||||||
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| AuthorizedOfficialLastName: | WARD | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | JANE | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3182124384 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | 232 | LA | Y | Hospital Units | Rehabilitation Unit |
No ID Information.