Provider Demographics
NPI:1629213079
Name:GOOD SHEPHERD AMBULATORY SURGICAL CENTER
Entity Type:Organization
Organization Name:GOOD SHEPHERD AMBULATORY SURGICAL CENTER
Other - Org Name:
Other - Org Type:
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:PO BOX 971062
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75397-1062
Mailing Address - Country:US
Mailing Address - Phone:903-315-5300
Mailing Address - Fax:903-315-5301
Practice Address - Street 1:703 E MARSHALL AVE
Practice Address - Street 2:SUITE 2000
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5500
Practice Address - Country:US
Practice Address - Phone:903-315-5300
Practice Address - Fax:903-315-5301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GSHS ENTERPRISES OPERATING #2, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-12
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXASC120261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical