Provider Demographics
NPI:1780649509
Name:GOOD SHEPHERD MEDICAL CENTER - LINDEN INC
Entity Type:Organization
Organization Name:GOOD SHEPHERD MEDICAL CENTER - LINDEN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BANOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-315-2000
Mailing Address - Street 1:404 N KAUFMAN ST
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:TX
Mailing Address - Zip Code:75563-5234
Mailing Address - Country:US
Mailing Address - Phone:903-756-5561
Mailing Address - Fax:903-756-3718
Practice Address - Street 1:404 N KAUFMAN ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:TX
Practice Address - Zip Code:75563-5234
Practice Address - Country:US
Practice Address - Phone:903-756-5561
Practice Address - Fax:903-756-3718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
TX008221282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183315401Medicaid
TX0004NPOtherBLUE CROSS/PROFESSIONAL PROVIDER #
TXHH0386OtherBLUE CROSS PROV#
TX0004NPOtherBLUE CROSS/PROFESSIONAL PROVIDER #
TX183315401Medicaid