Organization
GOOD SHEPHERD MEDICAL CENTER
Active
Parent organization
GOOD SHEPHERD MEDICAL CENTER
Other names
CHAMPION EMS
Organization subpart
Yes
Provider details
NPI number
Legal business name
GOOD SHEPHERD MEDICAL CENTER
Authorized official
EDWARD BANOS I (CEO)
(903) 315-2000
Entity
Organization
Contact information
Practice address
700 E MARSHALL AVE, LONGVIEW, TX 75601-5580
(903) 315-2000
Mailing address
700 E MARSHALL AVE, LONGVIEW, TX 75601-5580
(903) 315-2000
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
—
TX
3416L0300X
Land Ambulance
—
TX
343800000X
Secured Medical Transport (VAN)
—
TX
343900000X
Non-emergency Medical Transport (VAN)
—
TX
Other
Enumeration date
10/26/2006
Last updated
02/08/2010
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