NPIMap

Organization Active NPI

Willis-Knighton Medical Center, Inc.

Doing business as North Bossier Internal Medicine

  • Internal Medicine Physician
  • Bossier City, LA
National Provider Identifier
1679515118
Registry record updated Dec 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
WILLIS-KNIGHTON MEDICAL CENTER, INC.
Doing business as
North Bossier Internal Medicine
Practice address
2400 Hospital Dr
Suite 350
Bossier City, LA 71111-2385
Phone
(318) 212-7930
Fax
(318) 212-7935
NPI assigned
Jun 11, 2006
Last updated
Dec 20, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
WILLIS-KNIGHTON MEDICAL CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 20, 2011

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) 212-8780

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

2400 Hospital Dr
Suite 350
Bossier City, LA 71111-2385

Mailing address

2400 Hospital Dr
Suite 350
Bossier City, LA 71111-2385
Phone (318) 212-7930

Other identifiers 1

IdentifierTypeStateIssuer
1452866MedicaidLA

Other names 1

  • North Bossier Internal Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Willis Knighton Pierrem19 organizations share this tax ID, including this one
Part of
Willis Knighton Pierrem

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

Member of 1

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

NPI Registry JSON

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324339200000",
    "number": "1679515118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 HOSPITAL DR",
            "address_2": "SUITE 350",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112385",
            "telephone_number": "318-212-7930",
            "fax_number": "318-212-7935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 HOSPITAL DR",
            "address_2": "SUITE 350",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112385",
            "telephone_number": "318-212-7930",
            "fax_number": "318-212-7935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIS-KNIGHTON MEDICAL CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILLIS-KNIGHTON MEDICAL CENTER, INC.",
        "enumeration_date": "2006-06-11",
        "last_updated": "2011-12-20",
        "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": "318-212-8780"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1452866",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Bossier Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bossier City, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2011; 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.