WILLIS-KNIGHTON MEDICAL CENTER % MARK RICHARD MAINOUS (NPI# 1720014145) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720014145 |
| Entity Type | Organization |
| Organization Name | WILLIS-KNIGHTON MEDICAL CENTER % MARK RICHARD MAINOUS |
| Practice Address |
2400 Hospital Dr Suite 310 Bossier City LA 71111-2385 |
| Practice Telephone | 3182127810 |
| Practice Fax Number | 3182127815 |
| Mailing Telephone | 3182127810 |
| Mailing Fax Number | 3182127815 |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | GREG J. GAVIN (NETWORK ADMINISTRATOR) |
| Authorized Official Telephone | 3182127810 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0102X |
Surgery Specialization: Surgical Critical Care |
Allopathic & Osteopathic Physicians |
| Street Address |
2400 HOSPITAL DR SUITE 310 |
| City | BOSSIER CITY |
| State | LA |
| Zip Code | 71111-2385 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679576243 | Glenda Johnson | Obstetrics & Gynecology | 2400 Hospital Dr, Suite 240, Bossier City, LA 71111-2385 | 2005-05-27 |
| 1679126866 | Emily Rene Maddox | Nurse Practitioner | 2400 Hospital Dr, Bossier City, LA 71111-2385 | 2019-07-17 |
| 1689112526 | Guidco Medical, LLC | Hospitalist | 2400 Hospital Dr, Suite 130, Bossier City, LA 71111-2385 | 2017-02-10 |
| 1902258312 | Planchard Eye & Laser Center, L.L.C. | Ophthalmology | 2400 Hospital Dr, Suite 100, Bossier City, LA 71111-2385 | 2016-07-09 |
| 1558715367 | Joel Anthony Casale | Internal Medicine | 2400 Hospital Dr, Bossier City, LA 71111-2385 | 2016-04-18 |
| 1124482120 | Rachel Branton | Nurse Practitioner | 2400 Hospital Dr, Ste. 120, Bossier City, LA 71111-2385 | 2016-04-06 |
| 1619363116 | Lea J. Rimmer | Nurse Practitioner | 2400 Hospital Dr, Suite 340, Bossier City, LA 71111-2385 | 2015-04-10 |
| 1336576529 | Wk Neurology Clinic | Psychiatry & Neurology | 2400 Hospital Dr, Suite 310, Bossier City, LA 71111-2385 | 2013-10-02 |
| 1255763173 | Laura Michelle Mahaffey | Nurse Practitioner | 2400 Hospital Dr, Suite 340, Bossier City, LA 71111-2385 | 2013-08-01 |
| 1982047932 | Khalid Bin Ahmed Baosman | Internal Medicine | 2400 Hospital Dr, Suite 130, Bossier City, LA 71111-2385 | 2013-04-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669007951 | Tamara 'tammy' Larck | Counselor | 1525 Fullilove Drive, Shreveport, LA 71111 | 2020-03-06 |
| 1912538315 | Lagniappe Chiropractic | Chiropractor | 2400 Airline Drive, Bossier City, LA 71111 | 2020-02-04 |
| 1649817420 | Lifecare Medical Transportation, LLC. | Non-emergency Medical Transport (VAN) | 25 Duck Haven Pointe, Bossier City, LA 71111 | 2019-11-29 |
| 1770126344 | Bertresea White Evans | Nurse Practitioner | Coastal Urgernt Care, 5314 Airline Drive, Bossier City, LA 71111 | 2019-10-25 |
| 1861964058 | Erika Davis Reed | Counselor | 1515 Doctors Dr # 16, Bossier City, LA 71111 | 2018-12-28 |
| 1518436898 | Charlotte Mckay | Case Manager/Care Coordinator | 31330 Hwy 22, Ste 101, Bossier City, LA 71111 | 2018-11-16 |
| 1992271464 | Np2u, LLC | Nurse Practitioner | 2008 Airline Drive Suite 300 #194, Bossier City, LA 71111 | 2018-10-22 |
| 1114416542 | Lashaunda Autrey | Counselor | 410 Half Moon Lane, Bossier, LA 71111 | 2018-05-01 |
| 1750887196 | Shenya Williams-pennywell | Counselor | 1007 Gould Drive Bldg 2, Suite 1, Bossier City, LA 71111 | 2018-04-04 |
| 1336647304 | Patrick Vance | Physical Therapist | 5000 Benton Rd Ste 1, Bossier City, LA 71111 | 2018-01-24 |
| Find all providers in zip 71111 | ||||
| Taxonomy Code | 2086S0102X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Surgical Critical Care |
| A surgeon with expertise in the management of the critically ill and postoperative patient, particularly the trauma victim, who specializes in critical care medicine diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff and other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801181383 | Shahrzad Talebinejad | Surgery | 15770 Paul Vega Md Dr Ste 108a, Hammond, LA 70403 | 2011-06-13 |
| 1710203518 | Patrick Ryan Mcgrew | Surgery | 1430 Tulane Ave Ste 8530, New Orleans, LA 70112-2632 | 2010-04-19 |
| 1104093293 | Marquinn Dewan Duke | Surgery | 15813 Paul Vega Md Drive, Suite 100a, Hammond, LA 70403-1434 | 2008-05-08 |
| 1962606194 | Donald Ray Cowick | Surgery | 4301 Elysian Fields, New Orleans, LA 70122 | 2007-06-12 |
| 1376624213 | Juan C Duchesne | Surgery | 1430 Tulane Ave # Sl-22, New Orleans, LA 70112-2632 | 2006-10-18 |
| 1750601357 | Charles Townsend Harris | Surgery | 1415 Tulane Ave Fl 6, New Orleans, LA 70112 | 2010-06-04 |
| 1366766321 | Benjamin Reeves Martinez | Surgery | 7777 Hennessy Blvd, Suite 700, Baton Rouge, LA 70808-4300 | 2010-03-19 |
| 1356585533 | Chrissy Guidry | Surgery | 1430 Tulane Ave, New Orleans, LA 70112-2632 | 2009-05-01 |
| 1457531089 | Northwest Surgical Specialists Inc. | Surgery | 1801 Fairfield Ave, Suite 408, Shreveport, LA 71101-4468 | 2007-11-12 |
| 1740460351 | Michelle Antoinette Pittman | Surgery | 1801 Fairfield Ave, Suite 408, Shreveport, LA 71101-4443 | 2007-11-12 |
| Find all providers with the same taxonomy | ||||
| City | BOSSIER CITY |
| Zip Code | 71111 |
Please comment or provide details below to improve the information on WILLIS-KNIGHTON MEDICAL CENTER % MARK RICHARD MAINOUS.
| 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.