NPIMap

Organization Active NPI

Willis Knighton Medical Center, Inc.

Doing business as WK Renal Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Shreveport, LA
National Provider Identifier
1003020579
Registry record updated Jan 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
WILLIS KNIGHTON MEDICAL CENTER, INC.
Doing business as
WK Renal Dialysis
Practice address
1111 Line Avenue
Shreveport, LA 71101
Phone
(318) 212-4759
NPI assigned
May 10, 2007
Last updated
Jan 8, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mary Jane Ward
Title
Cfo
Phone
(318) 212-4384

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X NU Primary

Addresses

Primary practice location

1111 Line Avenue
Shreveport, LA 71101

Mailing address

2600 Greenwood Rd
Shreveport, LA 71103-3908

Other names 1

  • WK Renal Dialysis Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080625000448 LA Part A Provider - End-Stage Renal Disease Facility (ESRD) 0143110585 Practice locations: Shreveport, LA

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Willis Knighton Med Ctr-DialysisCCN 192308
Overall star rating
2.0 of 5
Ownership
Non-profit
Certified
Jun 12, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
13

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory
Tax ID family
WL Urgent Care Ctr-S19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Progressive Care CenterShreveport, LA, CCN 195136 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Trustee of the SNF
Adp of the SNF		 Sep 20, 1985
Jul 1, 2007
Jul 30, 2025
D Gregory Bell MD and Willis-Knighton Medical CenterCoushatta, LA, CCN 193895 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 1, 2007

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736294400000",
    "number": "1003020579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 GREENWOOD RD",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 LINE AVENUE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71101",
            "telephone_number": "318-212-4759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIS KNIGHTON MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2025-01-08",
        "certification_date": "2025-01-08",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "318-212-4384"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WK Renal Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.