Organization
WILLIS KNIGHTON MEDICAL CENTER INC. CRNA GROUP
Active
Other names
Willis Knighton Anesthesia Services
Organization subpart
No
Provider details
NPI number
Authorized official
STACY H ALEXANDER (CONTROLLER)
(318) 212-4877
Entity
Organization
Contact information
Practice address
2600 GREENWOOD RD, SHREVEPORT, LA 71103-3908
(318) 212-4877
Mailing address
2600 GREENWOOD RD, SHREVEPORT, LA 71103-3908
(318) 212-4877
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1441058
—
LA
Enumeration date
07/25/2006
Last updated
11/08/2012
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