Healthcare Provider Details

I. General information

NPI: 1760908404
Provider Name (Legal Business Name): CHRISTUS GOOD SHEPHERD MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 S WASHINGTON AVE
MARSHALL TX
75670-5336
US

IV. Provider business mailing address

811 S WASHINGTON AVE
MARSHALL TX
75670-5336
US

V. Phone/Fax

Practice location:
  • Phone: 903-927-6000
  • Fax: 903-927-6101
Mailing address:
  • Phone: 903-927-6000
  • Fax: 903-927-6101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: NORMAN TODD HANCOCK
Title or Position: PRESIDENT/CEO
Credential:
Phone: 903-315-4129