Provider Demographics
NPI:1962782532
Name:SHEPHERD'S CLINIC
Entity type:Organization
Organization Name:SHEPHERD'S CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEAMY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-467-7140
Mailing Address - Street 1:2800 KIRK AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-3647
Mailing Address - Country:US
Mailing Address - Phone:410-467-7140
Mailing Address - Fax:410-467-7141
Practice Address - Street 1:2800 KIRK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-3647
Practice Address - Country:US
Practice Address - Phone:410-467-7140
Practice Address - Fax:410-467-7141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health