Christus Good Shepherd Medical Center
Organization Active NPI Anesthesiology Physician · Marshall, TX
NPI 1760908404 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1760908404
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Anesthesiology Physician 207L00000X
- Legal business name
- CHRISTUS GOOD SHEPHERD MEDICAL CENTER
- Practice address
- 811 S Washington Ave
Marshall, TX 75670-5336 - Phone
- (903) 927-6000
- Fax
- (903) 927-6101
- NPI assigned
- Aug 15, 2017
- Organization subpart
- No
Authorized official
- Name
- Norman Todd Hancock
- Title
- President/Ceo
- Phone
- (903) 315-4129
Other NPIs on the same Medicare enrollment 4
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 5
Practitioners 109
-
Jeremiah Shea Andrews, CRNA
-
Roger Carl Bryant, C.R.N.A.
-
Ashley Renee' Dixon, CRNA
-
Tawonda Felton, CRNA
-
Clifton Fincher, CRNA
-
Niki Michelle Fincher, CRNA
-
Abby Nicole Godwin, CRNA
-
Stephen Daniel Harms, CRNA
-
Lee Allen Holladay, C.R.N.A.
-
Richard Johnson, CRNA
-
Erica Marie Korompai, CRNA
-
Zackary Gene Lister, C.R.N.A.
-
Tyler Pennal Littlejohn, DNAP - CRNA
-
David W Maly, CRNA
-
Joseph Alton McRee, CRNA
-
Kristin Renee Patterson, CRNA
-
James Ray Robinette, CRNA
-
Daniel Dwight Smith, CRNA
-
Robert Jason Steele, CRNA
-
Jeffrey Lee Williams, CRNA
-
Matthew Joshua Williams, CRNA
-
Robin Melinda Woodard, CRNA
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2036393 | Christus Good Shepherd Medical Center-Kilgore | Accreditation | Mar 25, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040604000400 | TX | Part B Supplier - Clinic/Group Practice | 3779565544 |
Receives reassigned benefits from 106 practitioners 4 other NPIs on this enrollment Practice locations: Marshall, TX; Longview, TX; Kilgore, TX |
National Provider Directory
- Tax ID family
- Marshall Regional Med C
Locations
620 S Grove St
Ste 104
Marshall, TX 75670
703 S Washington Ave
Marshall, TX 75670
Phone (903) 927-6880
612 S Grove St
Marshall, TX 75670
Phone (903) 927-6913
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician |
207L00000X | Yes | ||
| Neonatal Nurse Practitioner |
363LN0000X | |||
| Critical Care Neonatal Nurse Practitioner |
363LN0005X | |||
| Certified Registered Nurse Anesthetist |
367500000X |
Addresses
Primary practice location
811 S Washington Ave
Marshall, TX 75670-5336
Mailing address
811 S Washington Ave
Marshall, TX 75670-5336
Phone (903) 927-6000
Other practice location 1
700 E Marshall Ave
Longview, TX 75601-5580
Phone (903) 315-2000
Other practice location 2
703 E Marshall Ave Ste 2000
Longview, TX 75601-5500
Phone (903) 315-5300
Other practice location 3
1612 S Henderson Blvd
Kilgore, TX 75662-3518
Phone (903) 983-2492
Other practice location 4
323 E Hawkins Pkwy Ste D
Longview, TX 75605-8165
Phone (903) 544-6700
Other practice location 5
323 E Hawkins Pkwy Ste E
Longview, TX 75605-8166
Phone (903) 544-6700
Other providers in Marshall, TX
- Changing Lives Behavioral Health
- Jeri Kellett Charles
- Toney Lee Charles Jr.
- Choices Adolescent Treatment Ctr
- Christus Good Shepherd Medical Center
- City of Marshall
- Edna Clark
- Dwight Raymond Clemans
- Cody Whiddon Inc.
- Jayme Cole
All providers in Marshall, TX · Anesthesiology Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.