Willow Chute Medical, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WILLOW CHUTE MEDICAL, LLC

Practice address

4910 Airline Dr
Bossier City, LA 71111-6607

Phone

(318) 349-3921

NPI assigned

Dec 18, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Clint N. Wilson, M.D.NPI 1427269059

Title

Owner

Phone

(318) 349-3921

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Clint N. Wilson, M.D.

  • Family Medicine Physician
  • Bossier City, LA
  • NPI 1427269059
  Medicare reassignment NPD Authorized official
• Lisa Wilhite, RN,MSN,FNP-C

  • Family Nurse Practitioner
  • Bossier City, LA
  • NPI 1265047013
  NPD (past)

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

{
    "created_epoch": "1702857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703030400000",
    "number": "1033987151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "732 SMOKEHOUSE LOOP",
            "city": "BENTON",
            "state": "LA",
            "postal_code": "710068000",
            "telephone_number": "318-349-3921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4910 AIRLINE DR",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711116607",
            "telephone_number": "318-349-3921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW CHUTE MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-18",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-20",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "CLINT",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "318-349-3921",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Willis-Knighton Medical Center, Inc.
• Willis-Knighton Medical Center, Inc.
• Willis-Knighton Medical Center, Inc.
• Lindsey Willis, RBT
• Regina Renee Willis, N.P.
• Bruce Wilson
• Christopher M. Wilson, MD
• Clint N. Wilson, M.D.
• Dorothy Wilson
• Jeannie Wilson

• Family Medicine Physician in Bossier City, LA
• Providers in Bossier City, LA by specialty
• Family Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.