Organization Active NPI

Gary Williams MD and Willis-Knighton Medical Center

  • Internal Medicine Physician
  • Shreveport, LA
National Provider Identifier
1598796583
Registry record updated Jun 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
GARY WILLIAMS MD AND WILLIS-KNIGHTON MEDICAL CENTER
Practice address
2520 Bert Kouns Industrial Loop
Suite 202
Shreveport, LA 71118-3130
Phone
(318) 212-5040
Fax
(318) 212-5045
NPI assigned
Jul 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2012

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) 212-4232

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

2520 Bert Kouns Industrial Loop
Suite 202
Shreveport, LA 71118-3130

Mailing address

2520 Bert Kouns Industrial Loop
Suite 202
Shreveport, LA 71118-3130
Phone (318) 212-5040

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071217000727 LA Part B Supplier - Clinic/Group Practice 7911097712 Receives reassigned benefits from 1 practitioner
Practice locations: Shreveport, LA

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2520 Bert Kouns Industrial Loop
Ste 202
Shreveport, LA 71118
Phone (318) 212-5040

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339372800000",
    "number": "1598796583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2520 BERT KOUNS INDUSTRIAL LOOP",
            "address_2": "SUITE 202",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183130",
            "telephone_number": "318-212-5040",
            "fax_number": "318-212-5045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2520 BERT KOUNS INDUSTRIAL LOOP",
            "address_2": "SUITE 202",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183130",
            "telephone_number": "318-212-5040",
            "fax_number": "318-212-5045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY WILLIAMS MD AND WILLIS-KNIGHTON MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2012-06-11",
        "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": "318-212-4232"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal 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 Jun 11, 2012; 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.