Organization
WILLIS KNIGHTON MEDICAL CENTER, INC. WK EMERGENCY DEPT GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JESSE ALLEN (VP ANCILLARY SERVICES)
(318) 212-4500
Entity
Organization
Contact information
Practice address
2600 GREENWOOD RD, SHREVEPORT, LA 71103-3908
(318) 212-4500
Mailing address
2600 GREENWOOD RD, SHREVEPORT, LA 71103-3908
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
232
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447846
—
LA
Enumeration date
05/11/2006
Last updated
01/15/2008
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