1184678567 NPI number — GOOD SHEPHERD HEALTH CARE SYSTEM

Table of content: (NPI 1184678567)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184678567 NPI number — GOOD SHEPHERD HEALTH CARE SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOOD SHEPHERD HEALTH CARE SYSTEM
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:
6
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:
1184678567
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
610 NW 11TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERMISTON
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97838-6601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-667-3445
Provider Business Mailing Address Fax Number:
541-667-3454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
435 NW 11TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERMISTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97838-1412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-667-3477
Provider Business Practice Location Address Fax Number:
541-667-3476
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EDWARDS
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
REVENUE CYCLE DIRECTOR
Authorized Official Telephone Number:
541-667-3438

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 227927 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 082489000 . This is a "BLUE CROSS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 194609800 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 129688 . This is a "WASHINGTON DEPT OF L & I" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 7260409 . This is a "WASHINGTON DSHS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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