| Willis Knighton Behavioral Medicine Unit | |
|
1111 Line Avenue Shreveport LA 71101 | |
| (318) 212-5000 | |
| (318) 212-4192 |
| Full Name | Willis Knighton Behavioral Medicine Unit |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 1111 Line Avenue, Shreveport, Louisiana |
| Authorized Official Name and Position | Mary Jane Ward (CFO) |
| Authorized Official Contact | 3182124384 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Willis Knighton Behavioral Medicine Unit Po Box 32600 Shreveport LA 71130-2600 Ph: (318) 212-5000 | Willis Knighton Behavioral Medicine Unit 1111 Line Avenue Shreveport LA 71101 Ph: (318) 212-5000 |
| NPI Number | 1912059932 |
|---|---|
| Provider Enumeration Date | 01/18/2007 |
| Last Update Date | 02/17/2017 |
| Medicare PECOS PAC ID | 0143110585 |
|---|---|
| Medicare Enrollment ID | O20080630000471 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912059932 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 232A (Louisiana) | Primary |
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