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General NPI Number Information
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NPI Number | 1114985876
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Entity Type | Organization
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Legal Business Name | GOOD SHEPHERD MEDICAL CENTER - LINDEN, INC
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 07/26/2011
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Provider Practice Location Address
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Address Line | 903 N WALCOTT ST
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City | JEFFERSON
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State | TX
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Zip | 75657-1128
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Country | US
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Telephone | 903-665-9500
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Fax | 903-665-9501
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Provider Business Mailing Address
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Address Line | 404 N KAUFMAN ST
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City | LINDEN
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State | TX
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Zip | 75563-5234
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Country | US
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Telephone | 903-756-5581
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Fax | 903-756-5005
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ED D BANOS
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Credential |
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Telephone | 903-315-1811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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