NPIMap

Organization Active NPI

Willis Knighton Medical Center, Inc.

Doing business as Willis Knighton South Hospital

  • General Acute Care Hospital
  • Shreveport, LA
National Provider Identifier
1124170691
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
232-A Issued in LA
Legal business name
WILLIS KNIGHTON MEDICAL CENTER, INC.
Doing business as
Willis Knighton South Hospital
Practice address
2510 Bert Kouns Industrial Loop
Shreveport, LA 71118-3119
Phone
(318) 212-5003
Fax
(318) 212-5005
NPI assigned
Jan 17, 2007
Last updated
Aug 22, 2020By the provider in NPPES
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
Mrs. Stacy H Alexander
Title
Controller
Phone
(318) 212-4877

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 232-A LA Primary

Addresses

Primary practice location

2510 Bert Kouns Industrial Loop
Shreveport, LA 71118-3119

Mailing address

2510 Bert Kouns Industrial Loop
Shreveport, LA 71118-3119
Phone (318) 212-5003

Other names 1

  • Willis Knighton South Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080630000328 LA Part A Provider - Hospital 0143110585 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Shreveport, LA; Bossier City, LA; Benton, LA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1124170691. Details of each certification follow.

Hospital certification: CCN 190111

Legal name
WILLIS KNIGHTON MEDICAL CENTER, INC.
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Sep 27, 1967
Last certification
Nov 23, 2025
Beds
926
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Oct 10, 1949 in LA
Enrollment address
2600 Greenwood Road
Shreveport, LA 71103-3908
Other Hospital Practice Location
Hospital subgroups
General, Acute care

Hospital certification: CCN 190194

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
WILLIS KNIGHTON SOUTH HOSP
Certification status
Terminated Voluntary: merger or closure, Sep 30, 1994
Provider type (POS)
Hospital – Short-term
Participating since
Feb 11, 1983
Last certification
Nov 16, 1990
Beds
85
Ownership / control type
Private (for profit)
Facility address
2510 Bert Kouns Industrial Loop
Shreveport, LA 71118

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Willis Knighton Medical CenterCCN 190111 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D0649274Willis Knighton South Hospital2510 Bert Kouns Industrial Loop, Shreveport, LA 71118AccreditationFeb 27, 2027

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 disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Pierre Blanchard Individual Corporate DirectorTrustee Nov 1, 1983
Peggy Gavin Individual Corporate OfficerSenior Vice-President Jan 1, 2016
W-2 Managing EmployeeSenior Vice-President Jan 1, 2016
Mary Jane Ward Individual Corporate OfficerDirector of Decision Support Aug 1, 2014
W-2 Managing EmployeeDirector of Decision Support Aug 1, 2014
Lamar P. Pugh Individual Corporate DirectorTrustee Dec 14, 2021
Terri Smith Individual OtherSystem Accountant Sep 30, 2013
Eugene Bryson Individual Corporate DirectorTrustee May 27, 2014
Raymond J. Lasseigne Individual Corporate DirectorTrustee Jun 28, 2021
James K Elrod Individual Corporate DirectorBoard Member Aug 1, 1981
Jason E Cobb Individual Corporate Officer Jan 1, 2023
Margaret Elrod Individual Corporate OfficerSenior Vice-President Jan 1, 2016
W-2 Managing EmployeeSenior Vice-President Jan 1, 2016
Elaine J Simpkins Individual Corporate Director Jun 2, 2015
Richard H Sale Individual Corporate DirectorTrustee Jan 28, 2014
Danielle Faris Individual Corporate DirectorCorp Director of Hosp. Complianc May 1, 2022
W-2 Managing EmployeeCorp Director of Hosp. Complianc May 1, 2022
Frank B Hughes Individual Corporate DirectorTrustee - Chairman of the Board May 1, 1996
Jerry a Fielder Individual Corporate OfficerPresident Nov 28, 2017
W-2 Managing EmployeeChief Executive Officer Nov 28, 2017
Brian Crawford Individual Corporate Director Jan 9, 2019
W-2 Managing Employee Jan 9, 2019
Deborah D. Olds Individual Corporate Officer Feb 21, 2023

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 1,134

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

View all 1,134

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124170691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2510 BERT KOUNS INDUSTRIAL LOOP",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183119",
            "telephone_number": "318-212-5003",
            "fax_number": "318-212-5005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 BERT KOUNS INDUSTRIAL LOOP",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183119",
            "telephone_number": "318-212-5003",
            "fax_number": "318-212-5005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIS KNIGHTON MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ALEXANDER",
        "authorized_official_first_name": "STACY",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "318-212-4877",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "LA",
            "license": "232-A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willis Knighton South Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.