Healthcare Provider Details

I. General information

NPI: 1326002643
Provider Name (Legal Business Name): JACKSON COUNTY PUBLIC HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 HOSPITAL DRIVE
MAQUOKETA IA
52060-0910
US

IV. Provider business mailing address

601 HOSPITAL DRIVE
MAQUOKETA IA
52060-0910
US

V. Phone/Fax

Practice location:
  • Phone: 563-652-2474
  • Fax: 563-652-4096
Mailing address:
  • Phone: 563-652-2474
  • Fax: 563-652-4096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number490099H
License Number StateIA

VIII. Authorized Official

Name: CURT M COLEMAN
Title or Position: CEO
Credential:
Phone: 563-652-4020