Provider Demographics
NPI:1316341407
Name:JACK COUNTY HOSPITAL DISTRICT
Entity type:Organization
Organization Name:JACK COUNTY HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-567-6633
Mailing Address - Street 1:3301 VIEW ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103-2425
Mailing Address - Country:US
Mailing Address - Phone:817-531-3616
Mailing Address - Fax:817-535-6952
Practice Address - Street 1:3301 VIEW ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-2425
Practice Address - Country:US
Practice Address - Phone:817-531-3616
Practice Address - Fax:817-535-6952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004814Medicaid
TX455606Medicare Oscar/Certification