Organization
GOOD SHEPHERD MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD BANOS (CEO)
(903) 315-2000
Entity
Organization
Contact information
Practice address
718 HOLLYBROOK DR, LONGVIEW, TX 75605-2469
(936) 404-9420
Mailing address
718 HOLLYBROOK DR, LONGVIEW, TX 75605-2469
(936) 404-9420
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
716652
TX
Other
Enumeration date
01/18/2010
Last updated
01/19/2010
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