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DSH450037D GOOD SHEPHERD MEDICAL CENTER (Terminated)
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Main Details
Name
GOOD SHEPHERD MEDICAL CENTER
Subdivision Name
Kilgore ED
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450037D
Medicare Provider Number
450037
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/10/2014
Participating Start Date
7/1/2014
Participating Approval Date
6/13/2014
Last Recertification Date
8/28/2018
Termination Date
Termination Reason
7/1/2019
Other
Contacts
Authorizing Official
Christus Good Shepherd Medical Center
Jason Adams, COO
(903) 315-2440
Primary Contact
Christus Good Shepherd Medical Center
Jonathan Taylor Brown, Director
(903) 315-2019
Addresses
Street Address
1612 South Henderson Blvd.
Suite B
Kilgore, TX 75602
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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