Good Shepherd Community Clinic, Inc.

Primary specialty

Clinic PharmacyTaxonomy code 3336C0002X

Legal business name

GOOD SHEPHERD COMMUNITY CLINIC, INC.

Doing business as

Good Shepherd Community Clinic Pharmacy Walnut

Practice address

1104 Walnut Dr W
Ardmore, OK 73401

Phone

(580) 226-0543

NPI assigned

Apr 23, 2021

Last updated

Apr 23, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

GOOD SHEPHERD COMMUNITY CLINIC, INC.As reported in NPPES

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

Authorized official

Name

Teresa Myers

Title

Ceo

Phone

(580) 223-3411

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Good Shepherd Community Clinic Pharmacy Walnut Doing business as

Tax ID family

Good Shepherd Community Clinic Inc2 organizations share this tax ID, including this one

Part of

Good Shepherd Community Clinic Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Good Shepherd Community Clinic, Inc

  dba Good Shepherd Community Clinic Pharmacy

  • Clinic Pharmacy
  • Ardmore, OK
  • NPI 1730539487
  NPD tax ID

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

{
    "created_epoch": "1619136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619136000000",
    "number": "1316529803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 12TH AVE NW",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734015722",
            "telephone_number": "580-826-3575",
            "fax_number": "580-223-5113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 WALNUT DR W",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "73401",
            "telephone_number": "580-226-0543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SHEPHERD COMMUNITY CLINIC, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GOOD SHEPHERD COMMUNITY CLINIC, INC.",
        "enumeration_date": "2021-04-23",
        "last_updated": "2021-04-23",
        "certification_date": "2021-03-30",
        "status": "A",
        "authorized_official_last_name": "MYERS",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "580-223-3411"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "12-8917",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Good Shepherd Community Clinic Pharmacy Walnut",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katrina Jolynn Gonzalez
• Maria Gonzalez
• Sergio Gonzalez, CRNA
• Good Shepherd Community Clinic, Inc (Good Shepherd Community Clinic Pharmacy)
• Good Shepherd Community Clinic, Inc.
• Good Shepherd Hospice of Ardmore, LLC
• Josey Good
• Karli Goodwin
• Audra M Gordon, BACHELORS,CM
• Joshua Paul Gordon, D.O.

• Clinic Pharmacy in Ardmore, OK
• Providers in Ardmore, OK by specialty
• Clinic Pharmacy in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2021; 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.