Provider Demographics
NPI:1699800599
Name:JACKSON COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:JACKSON COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-782-5221
Mailing Address - Street 1:411 N WELLS ST
Mailing Address - Street 2:ROOM 206
Mailing Address - City:EDNA
Mailing Address - State:TX
Mailing Address - Zip Code:77957-2730
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:411 N WELLS ST
Practice Address - Street 2:ROOM 206
Practice Address - City:EDNA
Practice Address - State:TX
Practice Address - Zip Code:77957-2730
Practice Address - Country:US
Practice Address - Phone:361-782-5221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPH0020Medicare ID - Type UnspecifiedMEDICARE NUMBER