Provider Demographics
NPI:1295789667
Name:GOOD SHEPHERD HEALTH CARE SYSTEM
Entity type:Organization
Organization Name:GOOD SHEPHERD HEALTH CARE SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO & CFO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-667-3412
Mailing Address - Street 1:610 NW 11TH STREET
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-9696
Mailing Address - Country:US
Mailing Address - Phone:541-667-3400
Mailing Address - Fax:541-667-3715
Practice Address - Street 1:610 NW 11TH ST
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-6601
Practice Address - Country:US
Practice Address - Phone:541-667-3400
Practice Address - Fax:541-667-3715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QU0200X
OR282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3001302OtherWASHINGTON DSHS
OR008776Medicaid
WA0011096OtherWASHINGTON L & I
OR138002300OtherBLUE CROSS
OR194609800OtherUS DEPT OF LABOR
WA7260409OtherWASHINGTON DSHS
WA3001302OtherWASHINGTON DSHS
OR008776Medicaid
WA3001302OtherWASHINGTON DSHS
OR=========OtherMOST COMMERCIAL PAYERS