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NPI Code Detail

MEDICARE: THE GOOD SHEPHERD HOSPITAL, INC.

MEDICARE: THE 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
1207P00000XEmergency Medicine PhysicianTX
2207L00000XAnesthesiology Physician
3282N00000XGeneral Acute Care HospitalTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1HH0346OTHERTXBLUE CROSS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689663007
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE GOOD SHEPHERD HOSPITAL, INC.
Provider Business Mailing Address
First Line : 700 E MARSHALL AVE
Second Line :
City : LONGVIEW
State : TX
Zip : 75601-5580
Country : US
Telephone Number : 903-315-2000
Fax Number :
Provider Business Practice Location Address
First Line : 700 E MARSHALL AVE
Second Line :
City : LONGVIEW
State : TX
Zip : 75601-5580
Country : US
Telephone Number : 903-315-2000
Fax Number :
Authorized Official
Title or Position : PRESIDENT AND CEO
Name : MR. NORMAN TODD HANCOCK
Credential :
Telephone Number : 903-315-2000
Provider Enumeration Date : 10/18/2005
Last Update Date : 03/24/2017

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Directions to “THE GOOD SHEPHERD HOSPITAL, INC. ” Practice Location

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