Organization
WILLIS-KNIGHTON MEDICAL CENTER MARK RICHARD MAINOUS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-7810
Entity
Organization
Contact information
Practice address
2400 HOSPITAL DR, SUITE 310, BOSSIER CITY, LA 71111-2385
(318) 212-7810
(318) 212-7815
Mailing address
2400 HOSPITAL DR, SUITE 310, BOSSIER CITY, LA 71111-2385
(318) 212-7810
(318) 212-7815
Taxonomy
Speciality
Code
Description
License number
State
2086S0102X
Surgical Critical Care Physician
Primary
—
—
Other
Enumeration date
06/25/2006
Last updated
07/21/2022
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