JOHN MOISSIDIS MD AND WILLIS-KNIGHTON MEDICAL CENTER (NPI# 1417966888) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417966888 |
| Entity Type | Organization |
| Organization Name | JOHN MOISSIDIS MD AND WILLIS-KNIGHTON MEDICAL CENTER |
| Practice Address |
2551 Greenwood Rd Suite 310 Shreveport LA 71103-3981 |
| Practice Telephone | 3182128780 |
| Practice Fax Number | 3182128181 |
| Mailing Telephone | 3182128780 |
| Mailing Fax Number | 3182128181 |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | GREG J. GAVIN (NETWORK ADMINISTRATOR) |
| Authorized Official Telephone | 3182124571 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207K00000X | Allergy & Immunology | Allopathic & Osteopathic Physicians |
| Street Address |
2551 GREENWOOD RD SUITE 310 |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71103-3981 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528061959 | Amit Ahuja | Internal Medicine | 2551 Greenwood Rd, Suite 350, Shreveport, LA 71103-3981 | 2005-05-31 |
| 1457884819 | Wk Center for Endocrinology and Diabetes | Internal Medicine | 2551 Greenwood Rd, Suite 411, Shreveport, LA 71103-3981 | 2017-04-04 |
| 1053762146 | Caleb Harkins | Nurse Practitioner | 2551 Greenwood Rd, Suite #210, Shreveport, LA 71103-3981 | 2016-06-29 |
| 1538513429 | Wk Tri- State Neurosurgery Associates | Neurological Surgery | 2551 Greenwood Rd, Suite 320, Shreveport, LA 71103-3981 | 2016-04-18 |
| 1417326927 | Wk Advanced Laparoscopic and Robotic Surgery Specialists | Surgery | 2551 Greenwood Rd, Suite 310, Shreveport, LA 71103-3981 | 2015-09-15 |
| 1942678511 | James Reginald Hall IIi | Nurse Practitioner | 2551 Greenwood Rd, Suite 410, Shreveport, LA 71103-3981 | 2015-09-12 |
| 1437545282 | Wk North Hospitalists Group | Hospitalist | 2551 Greenwood Rd, Suite 410, Shreveport, LA 71103-3981 | 2015-04-08 |
| 1891198354 | Julie Kajor Broadwell | Physician Assistant | 2551 Greenwood Rd, Suite 140, Shreveport, LA 71103-3981 | 2014-09-29 |
| 1124467733 | Ambrosia T. Holsapple | Nurse Practitioner | 2551 Greenwood Rd, Suite 410, Shreveport, LA 71103-3981 | 2013-06-17 |
| 1528406915 | Wkn Tristate Neurology Clinic | Neurological Surgery | 2551 Greenwood Rd, Suite 240, Shreveport, LA 71103-3981 | 2013-06-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083124887 | Elizabeth Ponder | Case Manager/Care Coordinator | 404 Hearne Avenue, Shreveport, LA 71103 | 2017-10-05 |
| 1245648393 | Madiha Tariq | General Acute Care Hospital | Rheumatology Clinic, 1501 Kings Hwy, Sheveport, LA 71103 | 2014-07-31 |
| 1659782688 | Jennifer G Smith | Pharmacist | 1725 Claiborne Ave, Shreveport, LA 71103 | 2014-05-13 |
| 1336568823 | Taylor Jieun Jung | Student in an Organized Health Care Education/Training Program | Lsu Health Sciences Center 1501 Kings Highway, Department of Oral & Maxillofacial Surgery Room 530, Shreveport, LA 71103 | 2014-04-10 |
| 1578984746 | Jamie Terrell | Pharmacist | 1625 Claiborne Ave, Shreveport, LA 71103 | 2013-12-13 |
| 1346675188 | Srijan Tandukar | Internal Medicine | 2751 Albert L Bicknell Dr Ste 2b, Shreveport, LA 71103 | 2013-09-12 |
| 1699017681 | Deanna Elise Mossallati | Internal Medicine | 8551 Greenwood Rd, Suite 410, Shreveport, LA 71103 | 2013-03-18 |
| 1346527330 | Tim M Smith | Clinical Exercise Physiologist | 3200 Greenwood Rd., Shreveport, LA 71103 | 2011-11-04 |
| 1144451683 | Second Chance Recovery | Durable Medical Equipment & Medical Supplies | 3816 Linwood, Shreveport, LA 71103 | 2009-07-31 |
| 1093919920 | Neeraj Singh | Internal Medicine | 2751 Albert L Bicknell Dr Fl 4, Shreveport, LA 71103 | 2007-06-13 |
| Find all providers in zip 71103 | ||||
| Taxonomy Code | 207K00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Allergy & Immunology |
| An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Selected examples of such conditions include asthma, anaphylaxis, rhinitis, eczema, and adverse reactions to drugs, foods, and insect stings as well as immune deficiency diseases (both acquired and congenital), defects in host defense, and problems related to autoimmune disease, organ transplantation, or malignancies of the immune system. |
| Notes: Source: American Board of Medical Specialties, 2007, www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Allergy and Immunology, 2007. http://www.abai.org/ No subspecialty certificates in allergy and immunology are offered by the American Board of Allergy and Immunology (ABAI). The ABAI, however, does offer formal special pathways for physicians seeking dual certification in allergy/immunology and pediatric pulmonology; allergy/immunology and pediatric rheumatology; and allergy/immunology and adult rheumatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861791592 | Caroline Virginia Caperton | Allergy & Immunology | 2530 Bert Kouns Industrial Loop Ste 112, Shreveport, LA 71118-3153 | 2011-03-21 |
| 1801853106 | Gonzalo Alvarez Del Real | Allergy & Immunology | 1455 E Bert Kouns Industrial Loop # 108, Shreveport, LA 71105-5634 | 2006-04-28 |
| 1164482725 | David A Kaufman | Allergy & Immunology | 463 Ashley Ridge Blvd, Ste 100, Shreveport, LA 71106-7231 | 2006-03-27 |
| 1922533637 | Wk Allergy Asthma & Immunology Center | Allergy & Immunology | 2530 Bert Kouns Industrial Loop, Suite 112, Shreveport, LA 71118-3132 | 2017-05-01 |
| 1700138781 | Breatheamerica Shreveport Inc | Allergy & Immunology | 463 Ashley Ridge Blvd, Suite 100, Shreveport, LA 71106-7231 | 2012-10-15 |
| 1780802504 | Healing Grace Internal Medicine & Pediatrics, LLC | Allergy & Immunology | 6821 Pines Rd, Suite 200, Shreveport, LA 71129-2547 | 2007-04-24 |
| 1053308742 | Ioannis A. Moissidis | Allergy & Immunology | 850 Olive St, Suite B, Shreveport, LA 71104-2162 | 2005-09-29 |
| 1386648129 | Lori R Johnson | Allergy & Immunology | 1455 E Bert Kouns Loop, Shreveport, LA 71105-5634 | 2005-06-09 |
| 1982608659 | Willard F Washburne | Allergy & Immunology | 1455 E Bert Kouns Loop, Shreveport, LA 71105-5634 | 2005-06-09 |
| 1679577340 | Steven C Whited | Allergy & Immunology | 1455 E Bert Kouns Loop, Shreveport, LA 71105-5634 | 2005-06-09 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71103 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.