NPIMap

Organization Active NPI

Philip Kinnebrew, MD and Willis-Knighton Medical Center

  • Family Medicine Physician
  • Shreveport, LA
National Provider Identifier
1598700130
Registry record updated Oct 2, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PHILIP KINNEBREW, MD AND WILLIS-KNIGHTON MEDICAL CENTER
Practice address
2508 Bert Kouns Loop
Suite 102
Shreveport, LA 71118-3133
Phone
(318) 688-6630
Fax
(318) 688-6014
NPI assigned
Jun 18, 2006
Last updated
Oct 2, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2007

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) 688-6630

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

2508 Bert Kouns Loop
Suite 102
Shreveport, LA 71118-3133

Mailing address

2508 Bert Kouns Loop
Suite 102
Shreveport, LA 71118-3133
Phone (318) 688-6630

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191283200000",
    "number": "1598700130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2508 BERT KOUNS LOOP",
            "address_2": "SUITE 102",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183133",
            "telephone_number": "318-688-6630",
            "fax_number": "318-688-6014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2508 BERT KOUNS LOOP",
            "address_2": "SUITE 102",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183133",
            "telephone_number": "318-688-6630",
            "fax_number": "318-688-6014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILIP KINNEBREW, MD AND WILLIS-KNIGHTON MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-18",
        "last_updated": "2007-10-02",
        "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": "318-688-6630"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family 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 Oct 2, 2007; 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.