Provider Demographics
NPI:1124092036
Name:CHRISTUS GOOD SHEPHERD MEDICAL CENTER
Entity type:Organization
Organization Name:CHRISTUS GOOD SHEPHERD MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-315-4000
Mailing Address - Street 1:PO BOX 732041
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-2041
Mailing Address - Country:US
Mailing Address - Phone:903-315-2000
Mailing Address - Fax:903-315-2643
Practice Address - Street 1:700 E MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5580
Practice Address - Country:US
Practice Address - Phone:903-315-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTUS HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-15
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
TX273Y00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112667407Medicaid
TX112667408Medicaid
TX112667404Medicaid
TX112667405Medicaid
TX112667403Medicaid
TX022479201OtherTMHP ASC HASC
TX112667406Medicaid