MEDICARE: GOOD SHEPHERD MEDICAL CENTER - LINDEN, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CP3371	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	00H878	OTHER	BCBS OF TEXAS
3	127650	OTHER	SUPERIOR
4	0504760001	OTHER	DME

General Provider Information

NPI Number	:	1811954993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SHEPHERD MEDICAL CENTER - LINDEN, INC

Provider Business Mailing Address
First Line	:	404 N KAUFMAN ST
Second Line	:
City	:	LINDEN
State	:	TX
Zip	:	75563-5234
Country	:	US
Telephone Number	:	903-756-5581
Fax Number	:	903-756-5005

Provider Business Practice Location Address
First Line	:	201 E. 2ND STREET
Second Line	:
City	:	HUGHES SPRINGS
State	:	TX
Zip	:	75656-2597
Country	:	US
Telephone Number	:	903-639-2004
Fax Number	:	903-639-2007

Authorized Official
Title or Position	:	CEO
Name	:	MR. RUSSELL J COLLIER
Credential	:
Telephone Number	:	903-927-6734

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	01/16/2013

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Directions to “GOOD SHEPHERD MEDICAL CENTER - LINDEN, INC ” Practice Location

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