1255547980 NPI number — JACKSON MADISON COUNTY GENERAL HOSPITAL

Table of content: (NPI 1255547980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255547980 NPI number — JACKSON MADISON COUNTY GENERAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JACKSON MADISON COUNTY GENERAL HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SKILLED NURSING INFECTIOUS DISEASE RAD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255547980
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1804 HIGHWAY 45 BYP
Provider Second Line Business Mailing Address:
SUITE 604
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38305-4436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-660-8759
Provider Business Mailing Address Fax Number:
731-660-8739

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
708 W FOREST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38301-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-660-8759
Provider Business Practice Location Address Fax Number:
731-660-8739
Provider Enumeration Date:
05/16/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PHILLIPS
Authorized Official First Name:
JAMA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR PHYSICIAN BILLING
Authorized Official Telephone Number:
731-512-1510

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)