| Good Shepherd Glenn-garrett Clinic - Jefferson | |
|
903 N Walcott St Jefferson TX 75657-1128 | |
| (903) 665-9500 | |
| (903) 665-9501 |
| Full Name | Good Shepherd Glenn-garrett Clinic - Jefferson |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 903 N Walcott St, Jefferson, Texas |
| Authorized Official Name and Position | Ed D Banos (PRESIDENT) |
| Authorized Official Contact | 9033151811 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Good Shepherd Glenn-garrett Clinic - Jefferson 404 N Kaufman St Linden TX 75563-5234 Ph: (903) 756-5581 | Good Shepherd Glenn-garrett Clinic - Jefferson 903 N Walcott St Jefferson TX 75657-1128 Ph: (903) 665-9500 |
| NPI Number | 1114985876 |
|---|---|
| Provider Enumeration Date | 05/03/2006 |
| Last Update Date | 07/26/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114985876 | NPI | - | NPPES |
| 0504760001 | Other | DME | |
| 00H878 | Other | BC BS OF TEXAS | |
| 127650 | Other | SUPERIOR | |
| 130943706 | Medicaid | TX | |
| CP3371 | Other | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Jefferson Life Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 219 N Polk St, Jefferson, TX 75657 Phone: 903-247-0484 Fax: 903-247-0485 | |
East Texas Border Health Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 106 N Alley Street, Jefferson, TX 75657 Phone: 903-665-8453 Fax: 903-665-8496 | |
Jefferson Family Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 106 N Alley St, Jefferson, TX 75657 Phone: 903-665-1014 |