Basic Information
| Provider Information | |||||||||
| NPI: | 1992720676 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JACKSON MADISON COUNTY GENERAL HOSPITAL | ||||||||
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| OtherOrganizationName: | TRAUMA SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1804 HIGHWAY 45 BYP | ||||||||
| Address2: | SUITE 604 | ||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383054436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316608759 | ||||||||
| FaxNumber: | 7316608739 | ||||||||
| Practice Location | |||||||||
| Address1: | 708 W FOREST AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383013901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7314255385 | ||||||||
| FaxNumber: | 7314214369 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 05/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | PHILLIPS | ||||||||
| AuthorizedOfficialFirstName: | JAMA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR PHYSICIAN BILLING | ||||||||
| AuthorizedOfficialTelephone: | 7615121510 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | JACKSON MADISON COUNTY GENERAL HOSPITAL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | N | Hospitals | General Acute Care Hospital | Critical Access | 282NC2000X | N | Hospitals | General Acute Care Hospital | Children | 282NR1301X | N | Hospitals | General Acute Care Hospital | Rural | 282NW0100X | N | Hospitals | General Acute Care Hospital | Women | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.