Healthcare Provider Details

I. General information

NPI: 1336198159
Provider Name (Legal Business Name): GOOD SHEPHERD HEALTH CARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NW 11TH ST STE E33
HERMISTON OR
97838-8604
US

IV. Provider business mailing address

610 NW 11TH ST E37
HERMISTON OR
97838-6601
US

V. Phone/Fax

Practice location:
  • Phone: 541-667-3740
  • Fax: 541-667-3732
Mailing address:
  • Phone: 541-667-3486
  • Fax: 541-667-3487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JAN PETER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 541-667-3416