Organization
WILLIS KNIGHTON MEDICAL CENTER, INC.
Active
Other names
Home Health Departmant Willis Knighton Hospital Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MARY JANE WARD (DIR DECISION SUPPORT)
(318) 212-4384
Entity
Organization
Contact information
Practice address
3300 ALBERT L BICKNELL DR, SUITE 4, SHREVEPORT, LA 71103-3903
(318) 212-4180
(318) 212-4382
Mailing address
PO BOX 32600, SHREVEPORT, LA 71130-2600
(318) 212-4544
(318) 212-4192
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
65
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1400564
—
LA
01
—
33562
BLUE CROSS/BLUE SHIELD
LA
Enumeration date
05/24/2006
Last updated
12/05/2014
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