NPIMap

Organization Active NPI

Willis Knighton Medical Center, Inc.

  • Skilled Nursing Facility
  • Shreveport, LA
National Provider Identifier
1144267451
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
232 Issued in LA
Legal business name
WILLIS KNIGHTON MEDICAL CENTER, INC.
Practice address
2550 Kings Hwy
Shreveport, LA 71103-3922
Phone
(318) 212-8200
Fax
(318) 212-8220
NPI assigned
Jun 2, 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
Stacy H Alexander
Title
Controller
Phone
(318) 212-4877

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 232 LA Primary

Addresses

Primary practice location

2550 Kings Hwy
Shreveport, LA 71103-3922

Mailing address

PO Box 32600
Shreveport, LA 71130-2600
Phone (318) 212-8200

Other names 1

  • WK Extended Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060612000163 LA Part A Provider - Skilled Nursing Facility 0143110585 Practice locations: Shreveport, LA

Skilled nursing facility certification: CCN 195622

Legal name
WILLIS KNIGHTON MEDICAL CENTER, INC.
Doing business as
WK MEDICAL CENTER-EXTENDED CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF (Medicare) only
Participating since
Aug 22, 2006
Last certification
Mar 12, 2025
Beds
24
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Willis Knighton Health
Organization structure
CorporationNon-profit
Incorporated
Oct 10, 1949 in LA
Enrollment address
2550 Kings Highway
WK Extended Care Center
Shreveport, LA 71103-3922
Nursing home name
WILLIS-KNIGHTON EXTENDED CARE CENTER

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: Nursing home

Medicare Care Compare
Listed as
Willis-Knighton Extended Care CenterCCN 195622
Overall star rating
4 of 5
Health inspections
5 of 5
Staffing
1 of 5
Quality measures
3 of 5
Type
Medicare
Ownership
Non profit - Corporation
Certified
Aug 22, 2006
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
24

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Willis Knighton South H19 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

Member organizations 232

Organizations listed as members of this organization in the National Provider Directory.

View all 232

Locations

2550 Kings Hwy
Shreveport, LA 71103
Phone (318) 212-3200

Ownership & related parties

All disclosed owners & managing parties 18

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
Michael S Cook Individual W-2 Managing EmployeeSystem Accountant Aug 1, 2014
OtherSystem Accountant Aug 1, 2014
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 OfficerTrustee Dec 14, 2021
Terri Smith Individual OtherSystem Accountant Sep 30, 2013
Eugene Bryson Individual Corporate DirectorTrustee May 27, 2014
Raymond J. Lasseigne Individual Corporate DirectorTrusteee Jun 28, 2021
James K Elrod Individual Corporate DirectorBoard Member Aug 1, 1981
Jason E Cobb Individual Corporate OfficerSenior Vice President Jan 1, 2013
Margaret Elrod Individual Corporate OfficerSenior Vice-President Jan 1, 2016
W-2 Managing EmployeeSenior Vice-President Jan 1, 2016
Elaine J Simpkins Individual Corporate DirectorTrustee Jun 2, 2015
Richard H Sale Individual Corporate DirectorTrustee Jan 28, 2014
Danielle Faris Individual Corporate DirectorCorp Director of Hosp. Compliance May 1, 2022
W-2 Managing EmployeeCorp Director of Hosp. Compliance 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 Office Nov 28, 2017
Brian Crawford Individual Corporate OfficerSenior Vice President Jan 9, 2019
Deborah D. Olds Individual Corporate OfficerTrustee 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.

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.

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1144267451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 32600",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711302600",
            "telephone_number": "318-212-8200",
            "fax_number": "318-212-8220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 KINGS HWY",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033922",
            "telephone_number": "318-212-8200",
            "fax_number": "318-212-8220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIS KNIGHTON MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "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"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "LA",
            "license": "232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WK Extended Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.