Provider Demographics
NPI:1912138157
Name:GOOD SHEPHERD COMMUNITY DOCTORS OFFICE
Entity Type:Organization
Organization Name:GOOD SHEPHERD COMMUNITY DOCTORS OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:ETNA
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:330-782-2800
Mailing Address - Street 1:30 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44503-1417
Mailing Address - Country:US
Mailing Address - Phone:330-782-2800
Mailing Address - Fax:330-746-2855
Practice Address - Street 1:30 W FRONT ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44503-1417
Practice Address - Country:US
Practice Address - Phone:330-782-2800
Practice Address - Fax:330-746-2855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN245640261QC1500X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health