Provider Demographics
NPI:1861934721
Name:THE GOOD SHEPHERD MEDICAL CENTER LLC
Entity type:Organization
Organization Name:THE GOOD SHEPHERD MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUMMER
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMETRIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-807-6969
Mailing Address - Street 1:3080 E BAY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-2692
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9119 RIDGE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-5059
Practice Address - Country:US
Practice Address - Phone:727-807-6969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic