Willis Knighton Medical Center, Inc.
Organization Active NPI General Acute Care Hospital · Shreveport, LA
NPI 1124170691 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1124170691
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- 232-A (LA)
- Legal business name
- WILLIS KNIGHTON MEDICAL CENTER, INC.
- Practice address
- 2510 Bert Kouns Industrial Loop
Shreveport, LA 71118-3119 - Phone
- (318) 212-5003
- Fax
- (318) 212-5005
- NPI assigned
- Jan 17, 2007
- Organization subpart
- No
Authorized official
- Name
- Mrs. Stacy H Alexander
- Title
- Controller
- Phone
- (318) 212-4877
Owners & managing parties with NPI records 1
Other NPIs on the same Medicare enrollment 3
Corporate family (same tax ID) 18
Related certifications (CCN) 2
Affiliated clinicians 1,134
-
Emery Leigh Aaron, PA-C
-
David Abdehou, MD
-
Zulqarnain Abro, MD
-
Samuel K Abshire, MD
-
Noell S Ackel, PA
-
Mary Tillman Acosta, WHNP-BC
-
Michael T Acurio, MD
-
Humberto I Aguilar, M.D.
-
Furqan Akhtar, MD
-
Daniel B Albert, CRNA
-
Mary Melissa Albritton, M.D.
-
Ajit Alexander, MD
-
Calvin D. Alexander, M.D.
-
Sablaa Ali, D.O.
-
Sreedhara Babu Alla, M.D.
-
Larry Allen, M.D.
Medicare Care Compare: Hospital
- Listed as
- Willis Knighton Medical Center
- Overall star rating
- ★★★☆☆ 3 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 19D0649274 | Willis Knighton South Hospital | Accreditation | Feb 27, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
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
- Corporation · Non-profit
- Incorporated
- Oct 10, 1949 in LA
- Enrollment address
- 2600 Greenwood Road
Shreveport, LA 71103-3908 - Hospital subgroups
- General, Acute care
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Pierre Blanchard |
Corporate Director |
Nov 1, 1983 | |
| Peggy Gavin |
Corporate Officer |
Jan 1, 2016 | |
| W-2 Managing Employee |
Jan 1, 2016 | ||
| Mary Jane Ward |
Corporate Officer |
Aug 1, 2014 | |
| W-2 Managing Employee |
Aug 1, 2014 | ||
| Lamar P. Pugh |
Corporate Director |
Dec 14, 2021 | |
| Terri Smith |
Other |
Sep 30, 2013 | |
| Eugene Bryson |
Corporate Director |
May 27, 2014 | |
| Raymond J. Lasseigne |
Corporate Director |
Jun 28, 2021 | |
| James K Elrod |
Corporate Director |
Aug 1, 1981 | |
| Jason E Cobb |
Corporate Officer | Jan 1, 2023 | |
| Margaret Elrod |
Corporate Officer |
Jan 1, 2016 | |
| W-2 Managing Employee |
Jan 1, 2016 | ||
| Elaine J Simpkins |
Corporate Director | Jun 2, 2015 | |
| Richard H Sale |
Corporate Director |
Jan 28, 2014 | |
| Danielle Faris |
Corporate Director |
May 1, 2022 | |
| W-2 Managing Employee |
May 1, 2022 | ||
| Frank B Hughes |
Corporate Director |
May 1, 1996 | |
| Jerry a Fielder |
Corporate Officer |
Nov 28, 2017 | |
| W-2 Managing Employee |
Nov 28, 2017 | ||
| Brian Crawford |
Corporate Director | Jan 9, 2019 | |
| W-2 Managing Employee | Jan 9, 2019 | ||
| Deborah D. Olds |
Corporate Officer | Feb 21, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Willis Knighton South H
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 232-A | LA | Yes |
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
- Willis Knighton South Hospital
Other providers in Shreveport, LA
- Willis Knighton Health System
- Willis Knighton Medical Center Inc.
- Willis Knighton Medical Center Inc. Crna Group
- Willis Knighton Medical Center Inc. Crna Group
- Willis Knighton Medical Center, Inc.
- Willis Knighton Medical Center, Inc.
- Willis Knighton Medical Center, Inc.
- Willis Knighton Medical Center, Inc.
- Willis Knighton Medical Center, Inc.
- Willis Knighton Medical Center, Inc.
All providers in Shreveport, LA · General Acute Care Hospital in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.