Provider Demographics
NPI: | 1518283217 |
---|---|
Name: | GOOD SHEPHERD MEDICAL CENTER |
Entity Type: | Organization |
Organization Name: | GOOD SHEPHERD MEDICAL CENTER |
Other - Org Name: | ACUITY DIAGNOSTICS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT AND CEO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | STEVE |
Authorized Official - Middle Name: | P |
Authorized Official - Last Name: | ALTMILLER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 903-315-2000 |
Mailing Address - Street 1: | 700 E MARSHALL AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | LONGVIEW |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75601-5580 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 903-315-2000 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 700 E MARSHALL AVE |
Practice Address - Street 2: | |
Practice Address - City: | LONGVIEW |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75601-5580 |
Practice Address - Country: | US |
Practice Address - Phone: | 903-315-2000 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-04-20 |
Last Update Date: | 2015-02-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
291U00000X | ||
TX | 291U00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 291U00000X | Laboratories | Clinical Medical Laboratory |