Provider Demographics
NPI:1184678567
Name:GOOD SHEPHERD HEALTH CARE SYSTEM
Entity Type:Organization
Organization Name:GOOD SHEPHERD HEALTH CARE SYSTEM
Other - Org Name:GOOD SHEPHERD HOME MEDICAL EQUIPMENT, AND GOOD SHEPHERD MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-667-3438
Mailing Address - Street 1:610 NW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-6601
Mailing Address - Country:US
Mailing Address - Phone:541-667-3445
Mailing Address - Fax:541-667-3454
Practice Address - Street 1:435 NW 11TH ST
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-1412
Practice Address - Country:US
Practice Address - Phone:541-667-3477
Practice Address - Fax:541-667-3476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227927Medicaid
OR082489000OtherBLUE CROSS
OR194609800OtherUS DEPT OF LABOR
OR129688OtherWASHINGTON DEPT OF L & I
WA7260409OtherWASHINGTON DSHS
OR227927Medicaid
OR=========OtherMOST COMMERCIAL PAYERS