Organization
GOOD SHEPHERD AMBULATORY SURGICAL CENTER LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY D ADAIR (PRESIDENT/CEO)
(903) 315-2000
Entity
Organization
Contact information
Practice address
703 E MARSHALL AVE, SUITE 2000, LONGVIEW, TX 75601-5500
(903) 315-5300
(903) 315-5301
Mailing address
703 E MARSHALL AVE, SUITE 2000, LONGVIEW, TX 75601-5500
(903) 315-5300
(903) 315-5301
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
7792
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122076
CHIPS/SUPERIOR HEALTH PLA
TX
05
—
147239101
—
TX
01
—
HH1354
BCBS OF TEXAS
TX
Enumeration date
12/20/2005
Last updated
05/13/2009
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