Organization
GOOD SHEPHERD MEDICAL CENTER - LINDEN, INC
Active
Parent organization
GOOD SHEPHERD MEDICAL CENTER - LINDEN, INC
Other names
Good Shepherd Glenn-Garrett Clinic - Jefferson
Organization subpart
Yes
Provider details
NPI number
Legal business name
GOOD SHEPHERD MEDICAL CENTER - LINDEN, INC
Authorized official
MR. ED D BANOS (PRESIDENT)
(903) 315-1811
Entity
Organization
Contact information
Practice address
903 N WALCOTT ST, JEFFERSON, TX 75657-1128
(903) 665-9500
(903) 665-9501
Mailing address
404 N KAUFMAN ST, LINDEN, TX 75563-5234
(903) 756-5581
(903) 756-5005
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00H878
BC BS OF TEXAS
—
01
—
0504760001
DME
—
01
—
127650
SUPERIOR
—
05
—
130943706
—
TX
01
—
CP3371
RAILROAD MEDICARE
—
Enumeration date
05/03/2006
Last updated
07/26/2011
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