Provider Demographics
NPI:1295846434
Name:GOOD SHEPHERD IMAGING
Entity Type:Organization
Organization Name:GOOD SHEPHERD IMAGING
Other - Org Name:GOOD SHEPHERD IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:281-481-9729
Mailing Address - Street 1:10592A FUQUA ST # 243
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-1402
Mailing Address - Country:US
Mailing Address - Phone:281-481-9729
Mailing Address - Fax:281-481-9729
Practice Address - Street 1:10611 SAGEBRIAR DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-3305
Practice Address - Country:US
Practice Address - Phone:281-481-9729
Practice Address - Fax:281-481-9729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11365261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile