1124092036 NPI number — CHRISTUS GOOD SHEPHERD MEDICAL CENTER

Table of content: (NPI 1124092036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124092036 NPI number — CHRISTUS GOOD SHEPHERD MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTUS GOOD SHEPHERD MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124092036
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 732041
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75373-2041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-315-2000
Provider Business Mailing Address Fax Number:
903-315-2504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 E MARSHALL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONGVIEW
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75601-5580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-315-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HANCOCK
Authorized Official First Name:
NORMAN
Authorized Official Middle Name:
TODD
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
903-315-4000

Provider Taxonomy Codes

  • Taxonomy code: 273Y00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 022479201 . This is a "TMHP ASC HASC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 112667403 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 112667406 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 112667408 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 112667407 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 112667405 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 112667404 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 012368000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com