Provider Demographics
NPI:1336198159
Name:GOOD SHEPHERD HEALTH CARE SYSTEM
Entity Type:Organization
Organization Name:GOOD SHEPHERD HEALTH CARE SYSTEM
Other - Org Name:GOOD SHEPHERD MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-667-3416
Mailing Address - Street 1:610 NW 11TH ST
Mailing Address - Street 2:E37
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-6601
Mailing Address - Country:US
Mailing Address - Phone:541-667-3486
Mailing Address - Fax:541-667-3487
Practice Address - Street 1:600 NW 11TH ST STE E33
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-8604
Practice Address - Country:US
Practice Address - Phone:541-667-3740
Practice Address - Fax:541-667-3732
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOOD SHEPHERD HEALTH CARE SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-09
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR383985Medicare Oscar/Certification