Willis-Knighton Medical Center Mark Richard Mainous

Primary specialty

Surgical Critical Care PhysicianTaxonomy code 2086S0102X

Legal business name

WILLIS-KNIGHTON MEDICAL CENTER MARK RICHARD MAINOUS

Practice address

2400 Hospital Dr
Suite 310
Bossier City, LA 71111-2385

Phone

(318) 212-7810

Fax

(318) 212-7815

NPI assigned

Jun 25, 2006

Organization subpart

No

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) 212-7810

Specialties & licenses 1

Addresses

Member of 1

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

• Willis Knighton Medical Center, Inc.

  dba WK Renal Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Shreveport, LA
  • NPI 1003020579

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1720014145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 HOSPITAL DR",
            "address_2": "SUITE 310",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112385",
            "telephone_number": "318-212-7810",
            "fax_number": "318-212-7815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 HOSPITAL DR",
            "address_2": "SUITE 310",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112385",
            "telephone_number": "318-212-7810",
            "fax_number": "318-212-7815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIS-KNIGHTON MEDICAL CENTER MARK RICHARD MAINOUS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-25",
        "last_updated": "2022-07-21",
        "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": "318-212-7810"
    },
    "taxonomies": [
        {
            "code": "2086S0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Surgical Critical Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Willis Knighton Medical Center & M R Manchandia
• Willis Knighton Medical Center, Inc. (WK Bossier Health Center)
• Willis Knighton Ophthalmology Bossier
• Willis Transportation
• Willis-Knighton Medical Center and Diana M Lim MD
• Willis-Knighton Medical Center, Inc. (WK Bossier Womens Clinic)
• Willis-Knighton Medical Center, Inc. (Bossier Ear Nose and Throat)
• Willis-Knighton Medical Center, Inc. (North Bossier Internal Medicine)
• Lindsey Willis, RBT
• Regina Renee Willis, N.P.

• Surgical Critical Care Physician in Bossier City, LA
• Providers in Bossier City, LA by specialty
• Surgical Critical Care Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.