Southwest LTC Kilgore LTD

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

SOUTHWEST LTC KILGORE LTD

Doing business as

The Willows of Kilgore

Practice address

1901 Whipporwill LN
Kilgore, TX 75662-3880

Phone

(903) 983-7775

Fax

(903) 984-2244

NPI assigned

Oct 18, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ronald R Payne

Title

Manager

Phone

(469) 916-6100

Specialties & licenses 1

Addresses

Other names 1

• The Willows of Kilgore Doing business as

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

{
    "created_epoch": "1287360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289174400000",
    "number": "1619287273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 WHIPPORWILL LN",
            "city": "KILGORE",
            "state": "TX",
            "postal_code": "756623880",
            "telephone_number": "903-983-7775",
            "fax_number": "903-984-2244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 WHIPPORWILL LN",
            "city": "KILGORE",
            "state": "TX",
            "postal_code": "756623880",
            "telephone_number": "903-983-7775",
            "fax_number": "903-984-2244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST LTC KILGORE LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-18",
        "last_updated": "2010-11-08",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "469-916-6100"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Willows of Kilgore",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Jenna Marie St. Nicholas, PTA
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• Skilled Nursing Facility in Kilgore, TX
• Providers in Kilgore, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2010; 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.