Provider Demographics
NPI:1427164177
Name:JACKSON COUNTY HEALTHCARE AUTHORITY
Entity type:Organization
Organization Name:JACKSON COUNTY HEALTHCARE AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:NEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-218-3856
Mailing Address - Street 1:PO BOX 1050
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768
Mailing Address - Country:US
Mailing Address - Phone:256-218-3813
Mailing Address - Fax:256-218-3228
Practice Address - Street 1:380 WOODS COVE RD
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768
Practice Address - Country:US
Practice Address - Phone:256-218-3813
Practice Address - Fax:256-218-3228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SX0106XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOccupational HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL010121OtherBLUE CROSS