Healthcare Provider Details

I. General information

NPI: 1053348532
Provider Name (Legal Business Name): HSHS GOOD SHEPHERD HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S CEDAR ST
SHELBYVILLE IL
62565-1838
US

IV. Provider business mailing address

3051 HOLLIS DR
SPRINGFIELD IL
62704-7450
US

V. Phone/Fax

Practice location:
  • Phone: 217-774-3961
  • Fax: 217-774-5100
Mailing address:
  • Phone: 217-774-3961
  • Fax: 217-774-5713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number0002154
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: MARK D EVARD
Title or Position: VP OF REVENUE CYCLE
Credential:
Phone: 217-492-9651