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DSH190111ET WILLIS KNIGHTON MEDICAL CENTER, INC. (Approved)
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Main Details
Name
WILLIS KNIGHTON MEDICAL CENTER, INC.
Subdivision Name
WK NEUROVASCULAR NEUROSURGERY - WK Neurovascular Neurosurgery
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH190111ET
Medicare Provider Number
190111
Outpatient Facility Provider Number
Additional Details
Current Program Status
Approved
Registration Date
4/11/2025
Participating Start Date
7/1/2025
Participating Approval Date
5/27/2025
Last Recertification Date
Contacts
Authorizing Official
Willis-Knighton Medical Center
Mary Jane Ward, Senior Vice President - CFO
(318) 212-4384
Primary Contact
Willis-Knighton Medical Center
TESSA ALBRITTON, DIV. DIRECTOR OF PHARMACY
(318) 212-4039
Addresses
Street Address
2727 HEARNE AVE
STE 320
SHREVEPORT, LA 71103-3917
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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