NPIMap

Organization Active NPI

Good Shepherd Ambulatory Surgical Center LTD

  • Ambulatory Surgical Clinic/Center
  • Longview, TX
National Provider Identifier
1255317384
Registry record updated May 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
7792 Issued in TX
Legal business name
GOOD SHEPHERD AMBULATORY SURGICAL CENTER LTD
Practice address
703 E Marshall Ave
Suite 2000
Longview, TX 75601-5500
Phone
(903) 315-5300
Fax
(903) 315-5301
NPI assigned
Dec 20, 2005
Reactivated
May 13, 2009
Last updated
May 13, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jerry D Adair
Title
President/Ceo
Phone
(903) 315-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 7792 TX Primary

Addresses

Primary practice location

703 E Marshall Ave
Suite 2000
Longview, TX 75601-5500

Mailing address

703 E Marshall Ave
Suite 2000
Longview, TX 75601-5500
Phone (903) 315-5300

Other identifiers 3

IdentifierTypeStateIssuer
122076OtherTXCHIPS/SUPERIOR HEALTH PLA
147239101MedicaidTX
HH1354OtherTXBCBS OF TEXAS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242172800000",
    "number": "1255317384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 E MARSHALL AVE",
            "address_2": "SUITE 2000",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756015500",
            "telephone_number": "903-315-5300",
            "fax_number": "903-315-5301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 E MARSHALL AVE",
            "address_2": "SUITE 2000",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756015500",
            "telephone_number": "903-315-5300",
            "fax_number": "903-315-5301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SHEPHERD AMBULATORY SURGICAL CENTER LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-20",
        "last_updated": "2009-05-13",
        "deactivation_date": "2009-03-24",
        "reactivation_date": "2009-05-13",
        "status": "A",
        "authorized_official_last_name": "ADAIR",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "903-315-2000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TX",
            "license": "7792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIPS/SUPERIOR HEALTH PLA",
            "identifier": "122076",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "147239101",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TEXAS",
            "identifier": "HH1354",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.