Basic Information
| Provider Information | |||||||||
| NPI: | 1124092036 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHRISTUS GOOD SHEPHERD MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 732041 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753732041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033152000 | ||||||||
| FaxNumber: | 9033152504 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 E MARSHALL AVE | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756015580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033152000 | ||||||||
| FaxNumber: | 9033152504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 03/17/2021 | ||||||||
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| AuthorizedOfficialLastName: | HANCOCK | ||||||||
| AuthorizedOfficialFirstName: | NORMAN | ||||||||
| AuthorizedOfficialMiddleName: | TODD | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9033154000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GSHS, INC. | ||||||||
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| NPICertificationDate: | 03/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | TX | N | Hospital Units | Rehabilitation Unit | 282N00000X | TX | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 112667405 | 05 | TX | MEDICAID | 112667403 | 05 | TX | MEDICAID | 112667406 | 05 | TX | MEDICAID | 112667404 | 05 | TX | MEDICAID | 022479201 | 01 | TX | TMHP ASC HASC | OTHER | 112667407 | 05 | TX | MEDICAID | 112667408 | 05 | TX | MEDICAID |