Provider Demographics
NPI:1942573381
Name:GOOD SHEPHERD SURGICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:GOOD SHEPHERD SURGICAL ASSOCIATES, PLLC
Other - Org Name:GSPS GENERAL SURGERY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EVP/COO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-315-5704
Mailing Address - Street 1:PO BOX 4207
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75606-4207
Mailing Address - Country:US
Mailing Address - Phone:903-315-4400
Mailing Address - Fax:903-315-2595
Practice Address - Street 1:703 E MARSHALL AVE
Practice Address - Street 2:SUITE 3000
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5500
Practice Address - Country:US
Practice Address - Phone:903-315-4400
Practice Address - Fax:903-315-2595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty