Organization
HSHS GOOD SHEPHERD HOSPITAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK D EVARD (VP OF REVENUE CYCLE)
(217) 492-9651
Entity
Organization
Contact information
Practice address
200 SOUTH CEDAR, SHELBYVILLE, IL 62565
(217) 774-4499
(217) 774-6416
Mailing address
3051 HOLLIS DR, SPRINGFIELD, IL 62704-7450
(217) 774-3961
(217) 774-5713
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
1007384
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1007384
STATE LICENSE/REG #
IL
01
—
14D09002212
CLIA #
IL
01
—
9981
BLUE CROSS/BLUE SHIELD OF IL
IL
Enumeration date
07/27/2005
Last updated
10/31/2024
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