Provider Demographics
NPI:1477553998
Name:HSHS GOOD SHEPHERD HOSPITAL, INC.
Entity Type:Organization
Organization Name:HSHS GOOD SHEPHERD HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:EVARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-492-9651
Mailing Address - Street 1:3051 HOLLIS DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-7450
Mailing Address - Country:US
Mailing Address - Phone:217-774-3961
Mailing Address - Fax:217-774-5713
Practice Address - Street 1:200 SOUTH CEDAR
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62565
Practice Address - Country:US
Practice Address - Phone:217-774-4499
Practice Address - Fax:217-774-6416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-27
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1007384251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14D09002212OtherCLIA #
IL1007384OtherSTATE LICENSE/REG #
IL9981OtherBLUE CROSS/BLUE SHIELD OF IL
147622Medicare Oscar/Certification
IL1007384OtherSTATE LICENSE/REG #
147622Medicare Oscar/Certification
IL=========Medicare ID - Type Unspecified