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DSH190111A WILLIS KNIGHTON MEDICAL CENTER, INC. (Terminated)
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Main Details
Name
WILLIS KNIGHTON MEDICAL CENTER, INC.
Subdivision Name
WILLIS KNIGHTON SOUTH HOSPITAL
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH190111A
Medicare Provider Number
190111
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
11/29/2006
Participating Start Date
1/1/2007
Participating Approval Date
11/30/2006
Last Recertification Date
8/20/2019
Termination Date
Termination Reason
4/1/2020
Other
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
2510 BERT KOUNS
SHREVEPORT, LA 71118
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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