MEDICARE: HSHS GOOD SHEPHERD HOSPITAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	1007384	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9981	OTHER	IL	BLUE CROSS/BLUE SHIELD OF IL
2	14D09002212	OTHER	IL	CLIA #
3	1007384	OTHER	IL	STATE LICENSE/REG #

General Provider Information

NPI Number	:	1477553998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HSHS GOOD SHEPHERD HOSPITAL INC

Provider Business Mailing Address
First Line	:	3051 HOLLIS DR
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-7450
Country	:	US
Telephone Number	:	217-774-3961
Fax Number	:	217-774-5713

Provider Business Practice Location Address
First Line	:	200 SOUTH CEDAR
Second Line	:
City	:	SHELBYVILLE
State	:	IL
Zip	:	62565
Country	:	US
Telephone Number	:	217-774-4499
Fax Number	:	217-774-6416

Authorized Official
Title or Position	:	VP OF REVENUE CYCLE
Name	:	MARK D EVARD
Credential	:
Telephone Number	:	217-492-9651

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	10/31/2024

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Directions to “HSHS GOOD SHEPHERD HOSPITAL INC ” Practice Location

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