NPIMap

Organization Active NPI

Paul S Wilson MD and Willis-Knighton Medical Center

  • Internal Medicine Physician
  • Shreveport, LA
National Provider Identifier
1003847013
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PAUL S WILSON MD AND WILLIS-KNIGHTON MEDICAL CENTER
Practice address
1666 E Bert Kouns Industrial Loop
Suite 230
Shreveport, LA 71105-5714
Phone
(318) 212-3970
Fax
(318) 212-3975
NPI assigned
Jul 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Greg J. Gavin
Title
Network Administrator
Phone
(318) 212-3970

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1666 E Bert Kouns Industrial Loop
Suite 230
Shreveport, LA 71105-5714

Mailing address

1666 E Bert Kouns Industrial Loop
Suite 230
Shreveport, LA 71105-5714
Phone (318) 212-3970

National Provider Directory

National Provider Directory

Locations

1666 E Bert Kouns Industrial Loop
Ste 230
Shreveport, LA 71105
Phone (318) 212-2750

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003847013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1666 E BERT KOUNS INDUSTRIAL LOOP",
            "address_2": "SUITE 230",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055714",
            "telephone_number": "318-212-3970",
            "fax_number": "318-212-3975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1666 E BERT KOUNS INDUSTRIAL LOOP",
            "address_2": "SUITE 230",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055714",
            "telephone_number": "318-212-3970",
            "fax_number": "318-212-3975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL S WILSON MD AND WILLIS-KNIGHTON MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GAVIN",
        "authorized_official_first_name": "GREG",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "NETWORK ADMINISTRATOR",
        "authorized_official_telephone_number": "318-212-3970"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.