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DSH190111CE WILLIS KNIGHTON MEDICAL CENTER, INC. (Active)
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Main Details
Name
WILLIS KNIGHTON MEDICAL CENTER, INC.
Subdivision Name
WK SPECIALTY PEDIATRICS CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH190111CE
Medicare Provider Number
190111
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/16/2017
Participating Start Date
1/1/2018
Participating Approval Date
10/24/2017
Last Recertification Date
8/17/2024
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
2032 ELIZABETH ST
SHREVEPORT, LA 71111
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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