Provider Demographics
NPI:1104816966
Name:JACKSON-MADISON COUNTY GENERAL HOSPITAL
Entity type:Organization
Organization Name:JACKSON-MADISON COUNTY GENERAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-541-5000
Mailing Address - Street 1:1804 HIGHWAY 45 BYP
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-4436
Mailing Address - Country:US
Mailing Address - Phone:731-664-4220
Mailing Address - Fax:731-664-4231
Practice Address - Street 1:1804 HIGHWAY 45 BYP
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-4436
Practice Address - Country:US
Practice Address - Phone:731-664-4220
Practice Address - Fax:731-664-4231
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACKSON-MADISON COUNTY GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-24
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000335251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN441514Medicare Oscar/Certification