Organization
D GREGORY BELL MD AND WILLIS-KNIGHTON MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 932-2170
Entity
Organization
Contact information
Practice address
1633 MARVEL ST, COUSHATTA, LA 71019-9022
(318) 932-2170
(318) 932-2242
Mailing address
PO BOX 506, COUSHATTA, LA 71019-0506
(318) 932-2170
(318) 932-2242
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
193895
MEDICAID RURAL HEALTH
LA
05
—
2143263
—
LA
Enumeration date
06/19/2006
Last updated
06/08/2012
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