Provider Demographics
NPI:1427035039
Name:GOOD SHEPHERD REHABILITATION HOSPITAL
Entity Type:Organization
Organization Name:GOOD SHEPHERD REHABILITATION HOSPITAL
Other - Org Name:GOOD SHEPHERD PHYSICIAN GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-776-3130
Mailing Address - Street 1:850 S 5TH ST
Mailing Address - Street 2:5TH FLOOR BILLING
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-3295
Mailing Address - Country:US
Mailing Address - Phone:610-778-9297
Mailing Address - Fax:610-778-9270
Practice Address - Street 1:850 S 5TH ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3295
Practice Address - Country:US
Practice Address - Phone:610-776-3278
Practice Address - Fax:610-776-3326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001067152W00000X
207R00000X
PA208000000X, 2080P0006X, 208100000X, 2081P0010X, 2083X0100X, 2084N0400X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty
No2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation MedicineGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1522925OtherGATEWAY
PA20010003OtherAMERI-HEALTH MERCY
PA100760823Medicaid
PA1365410OtherHIGHMARK
PA02344000OtherCAPTIAL BLUE CROSS
PA02344000OtherCAPTIAL BLUE CROSS