Provider Demographics
NPI:1205894961
Name:GOOD SHEPHERD MEDICAL CENTER - LINDEN, INC
Entity type:Organization
Organization Name:GOOD SHEPHERD MEDICAL CENTER - LINDEN, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-927-6734
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:903-756-5581
Mailing Address - Fax:903-756-5005
Practice Address - Street 1:402 N KAUFMAN
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:903-756-5581
Practice Address - Fax:903-756-5005
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOOD SHEPHERD MEDICAL CENTER - LINDEN, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-03
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
127650OtherSUPERIOR HEALTH
0504760001OtherDME
TX130943705Medicaid
CP3371OtherRAILROAD MEDICARE
CP3371OtherRAILROAD MEDICARE