1295789667 NPI number — GOOD SHEPHERD HEALTH CARE SYSTEM

Table of content: (NPI 1295789667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295789667 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:
1295789667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
610 NW 11TH STREET
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:
97838-9696
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-667-3400
Provider Business Mailing Address Fax Number:
541-667-3715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 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:
97838-6601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-667-3400
Provider Business Practice Location Address Fax Number:
541-667-3715
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:
COO & CFO
Authorized Official Telephone Number:
541-667-3412

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , 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: 3001302 . This is a "WASHINGTON DSHS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 008776 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0011096 . This is a "WASHINGTON L & I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 138002300 . 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: 7260409 . This is a "WASHINGTON DSHS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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