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

Practice address

20 12TH Ave NW
Ardmore, OK 73401-5722

Phone

(580) 223-3411

NPI assigned

Jun 14, 2016

Organization subpart

No

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

Authorized official

Name

Teresa Myers

Title

Executive Director

Phone

(580) 223-3411

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Good Shepherd Community Clinic Pharmacy Doing business as

Tax ID family

Good Shepherd Comm Clinic2 organizations share this tax ID, including this one

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 Walnut

  • Clinic Pharmacy
  • Ardmore, OK
  • NPI 1316529803
  NPD tax ID

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/21725/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1465862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1730539487",
    "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": "580-223-3411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 12TH AVE NW",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734015722",
            "telephone_number": "580-223-3411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SHEPHERD COMMUNITY CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-14",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "MYERS",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "580-223-3411"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "3729514",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OKLAHOMA STATE BOARD OF PHARMACY LICENSE",
            "identifier": "12-8483",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Good Shepherd Community Clinic Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elizabeth Gomez
• Jimena Gonzalez
• Katrina Jolynn Gonzalez
• Maria Gonzalez
• Sergio Gonzalez, CRNA
• Good Shepherd Community Clinic, Inc.
• Good Shepherd Community Clinic, Inc. (Good Shepherd Community Clinic Pharmacy Walnut)
• Good Shepherd Hospice of Ardmore, LLC
• Josey Good
• Karli Goodwin

• 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 Mar 7, 2023; 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.