Healthcare Provider Details

I. General information

NPI: 1811753924
Provider Name (Legal Business Name): JACKSON HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 JETT DR
JACKSON KY
41339-9622
US

IV. Provider business mailing address

1573 MALLORY LN STE 100
BRENTWOOD TN
37027-2895
US

V. Phone/Fax

Practice location:
  • Phone: 606-666-6000
  • Fax: 606-666-6102
Mailing address:
  • Phone: 615-221-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: LAURA J FEY
Title or Position: VP PHYSICIAN PRACTICE
Credential:
Phone: 615-221-3641