Healthcare Provider Details

I. General information

NPI: 1508901554
Provider Name (Legal Business Name): GOOD SHEPHERD MEDICAL GROUP RHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NW 11TH ST SUITE E-37
HERMISTON OR
97838-8602
US

IV. Provider business mailing address

600 NW 11TH ST SUITE E-37
HERMISTON OR
97838-8602
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number140334
License Number StateOR

VIII. Authorized Official

Name: DENNIS BURKE
Title or Position: CEO
Credential:
Phone: 541-667-3400