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DSH450032D GOOD SHEPHERD MEDICAL CTR - MARSHALL (Terminated)
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Main Details
Name
GOOD SHEPHERD MEDICAL CTR - MARSHALL
Subdivision Name
First in Pediatrics RHC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450032D
Medicare Provider Number
450032
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/16/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/15/2017
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
304 University Ave.
Suite 105
Marshall, TX 75670
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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