Provider Demographics
NPI:1104816792
Name:JACKSON-MADISON COUNTY GENERAL HOSPITAL DISTRICT
Entity type:Organization
Organization Name:JACKSON-MADISON COUNTY GENERAL HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-425-5000
Mailing Address - Street 1:33 DIRECTORS ROW
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2316
Mailing Address - Country:US
Mailing Address - Phone:731-984-2000
Mailing Address - Fax:731-984-2079
Practice Address - Street 1:33 DIRECTORS ROW
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2315
Practice Address - Country:US
Practice Address - Phone:731-984-2000
Practice Address - Fax:731-984-2079
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACKSON-MADISON COUNTY GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-25
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000174251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0044-7101Medicaid
TN0044-7101Medicaid