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DSH450032A GOOD SHEPHERD MEDICAL CENTER - MARSHALL (Terminated)
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Main Details
Name
GOOD SHEPHERD MEDICAL CENTER - MARSHALL
Subdivision Name
Marshall Pediatric Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450032A
Medicare Provider Number
450032
Outpatient Facility Provider Number
458824
Additional Details
Current Program Status
Terminated
Registration Date
10/13/2016
Participating Start Date
1/1/2017
Participating Approval Date
10/28/2016
Last Recertification Date
Termination Date
Termination Reason
10/1/2017
Site closure
Contacts
Authorizing Official
Good Shepherd Medical Center
Michael Cheek, CFO
(903) 315-1814
Primary Contact
Good Shepherd Medical Center - Marshall
Keith Creel, Vice President of Ancillary Services
(903) 927-6797
Addresses
Street Address
707 S. Grove
Marshall, TX 75670
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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10/20/16; Participating 4/1/2009 until terminated effective 10/1/2016, reinstated effective 1/1/2017.
10/28/2016
April 2025
April 2025
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