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NPI Code Detail

MEDICARE: JACKSON COUNTY HOSPITAL DISTRICT

MEDICARE: JACKSON COUNTY HOSPITAL DISTRICT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR1300XRural Health Clinic/Center
2282NR1301XRural Acute Care Hospital
3282N00000XGeneral Acute Care Hospital

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538108725
Entity Type Code : Organization
Provider Name (Legal Business Name) : JACKSON COUNTY HOSPITAL DISTRICT
Provider Business Mailing Address
First Line : 4250 HOSPITAL DR
Second Line : PO BOX 1608
City : MARIANNA
State : FL
Zip : 32446-1917
Country : US
Telephone Number : 850-526-2200
Fax Number : 850-718-2649
Provider Business Practice Location Address
First Line : 4250 HOSPITAL DR
Second Line :
City : MARIANNA
State : FL
Zip : 32446-1917
Country : US
Telephone Number : 850-526-2200
Fax Number : 850-718-2649
Authorized Official
Title or Position : CFO
Name : KELLY CONNOLLY
Credential :
Telephone Number : 850-718-2623
Provider Enumeration Date : 06/05/2006
Last Update Date : 01/05/2024

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Directions to “JACKSON COUNTY HOSPITAL DISTRICT ” Practice Location

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