Provider Demographics
NPI:1629193057
Name:WILLIS KNIGHTON HEALTH SYSTEM
Entity type:Organization
Organization Name:WILLIS KNIGHTON HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD OF CRNA
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SACKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-212-4072
Mailing Address - Street 1:1024 CRESSMONT ST
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-5759
Mailing Address - Country:US
Mailing Address - Phone:318-741-1659
Mailing Address - Fax:
Practice Address - Street 1:8001 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2302
Practice Address - Country:US
Practice Address - Phone:318-212-3220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05106282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital