Willis Knighton Medical Center, Inc.
Organization Active NPI Rehabilitation Hospital Unit · Shreveport, LA
NPI 1710039896 · NPPES record last updated Feb 17, 2017
Key facts
- NPI
- 1710039896
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rehabilitation Hospital Unit 273Y00000X
- License
- 232 (LA)
- Legal business name
- WILLIS KNIGHTON MEDICAL CENTER, INC.
- Practice address
- 1111 Line Avenue
Shreveport, LA 71101 - Phone
- (318) 212-4877
- Fax
- (318) 212-4192
- NPI assigned
- Jan 17, 2007
- Organization subpart
- No
Authorized official
- Name
- Mary Jane Ward
- Title
- Cfo
- Phone
- (318) 212-4384
Owners & managing parties with NPI records 1
Owned or controlled facilities with NPI records 2
Other NPIs with the same Medicare PAC ID 7
Corporate family (same tax ID) 18
Related certifications (CCN) 4
Practitioners 1
Affiliated clinicians 6
-
Ashok R Kompelli, MD
-
Huan Q Le, MD
Medicare Care Compare: Inpatient rehabilitation facility
- Listed as
- Willis-Knighton Medical Center
- Ownership
- Non-profit
- Certified
- Oct 1, 1991
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Hospital certification: CCN 19T111
- Legal name
- WILLIS KNIGHTON MEDICAL CENTER, INC.
- Doing business as
- WILLIS KNIGHTON REHABILITATION UNIT
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 10, 1949 in LA
- Enrollment address
- 1111 Line Avenue
Shreveport, LA 71101-3841 - Hospital subgroups
- Rehabilitation unit
All disclosed owners & managing parties 18
| Name | Role | Since | Share |
|---|---|---|---|
| Pierre Blanchard |
Corporate Director |
Nov 1, 1983 | |
| Peggy Gavin |
Corporate Officer |
Jan 1, 2016 | |
| W-2 Managing Employee |
Jan 1, 2016 | ||
| Michael S Cook |
W-2 Managing Employee |
Aug 1, 2014 | |
| Other |
Aug 1, 2014 | ||
| Mary Jane Ward |
Corporate Officer |
Aug 1, 2014 | |
| W-2 Managing Employee |
Aug 1, 2014 | ||
| Lamar P. Pugh |
Corporate Director |
Dec 14, 2021 | |
| Terri Smith |
Other |
Sep 30, 2013 | |
| Eugene Bryson |
Corporate Director |
May 27, 2014 | |
| Raymond J. Lasseigne |
Corporate Director |
Jun 28, 2021 | |
| James K Elrod |
Corporate Director |
Aug 1, 1981 | |
| Jason E Cobb |
Corporate Officer | Jan 1, 2023 | |
| Margaret Elrod |
Corporate Officer |
Jan 1, 2016 | |
| W-2 Managing Employee |
Jan 1, 2016 | ||
| Elaine J Simpkins |
Corporate Director |
Jun 2, 2015 | |
| Richard H Sale |
Corporate Director |
Jan 28, 2014 | |
| Danielle Faris |
Corporate Director |
May 1, 2022 | |
| W-2 Managing Employee |
May 1, 2022 | ||
| Frank B Hughes |
Corporate Director |
May 1, 1996 | |
| Jerry a Fielder |
Corporate Officer |
Nov 28, 2017 | |
| W-2 Managing Employee |
Nov 28, 2017 | ||
| Brian Crawford |
Corporate Officer | Jan 9, 2019 | |
| Deborah D. Olds |
Corporate Officer |
Feb 21, 2023 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Progressive Care Center |
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 Center |
Rural health clinic | 5% Or Greater Direct Ownership Interest | Jan 1, 2007 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080630000454 | LA | Part a Provider - Hospital | 0143110585 | Practice locations: Shreveport, LA |
National Provider Directory
- Tax ID family
- Willis Knighton South H
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Hospital Unit | 273Y00000X | 232 | LA | Yes |
Addresses
Primary practice location
1111 Line Avenue
Shreveport, LA 71101
Mailing address
PO Box 32600
Shreveport, LA 71130-2600
Phone (318) 212-4000
Other names
- Willis Knighton Rehabilitation Unit
Other providers in Shreveport, LA
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- Willis Knighton Medical Center, Inc. WK Emergency Dept Group
- Willis Knighton Work Kare
- Willis-Knighton Medical Center & Johnston Johnny MD
All providers in Shreveport, LA · Rehabilitation Hospital Unit in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 17, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.