Provider Demographics
NPI:1609901834
Name:GOOD SHEPHERD FIRST
Entity Type:Organization
Organization Name:GOOD SHEPHERD FIRST
Other - Org Name:FAMILY HEALTH CARE INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SHIFFLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-422-3999
Mailing Address - Street 1:PO BOX 4370
Mailing Address - Street 2:1230 GARFIELD
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26102
Mailing Address - Country:US
Mailing Address - Phone:304-422-3999
Mailing Address - Fax:304-422-1454
Practice Address - Street 1:1230 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26102
Practice Address - Country:US
Practice Address - Phone:304-422-3999
Practice Address - Fax:304-422-1454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20094WV207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5630264001Medicaid
G59582Medicare UPIN
9326821Medicare ID - Type Unspecified