Provider Demographics
NPI:1366432122
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 1:1061 WEST FOREST AVENUE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3879
Mailing Address - Country:US
Mailing Address - Phone:731-660-6954
Mailing Address - Fax:731-660-3549
Practice Address - Street 1:1061 WEST FOREST AVENUE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3879
Practice Address - Country:US
Practice Address - Phone:731-660-6954
Practice Address - Fax:731-660-3549
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACKSON-MADISON COUNTY GENERAL HO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-24
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003211251F00000X
TN419332B00000X, 332BP3500X, 332BX2000X
TN3211333600000X
3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0547380002Medicare NSC