Healthcare Provider Details

I. General information

NPI: 1780692400
Provider Name (Legal Business Name): JACKSON COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 LANSING AVE
JACKSON MI
49202-2193
US

IV. Provider business mailing address

1715 LANSING AVE
JACKSON MI
49202-2192
US

V. Phone/Fax

Practice location:
  • Phone: 517-788-4420
  • Fax: 517-788-4373
Mailing address:
  • Phone: 517-788-4420
  • Fax: 517-788-4373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY HOBART
Title or Position: SR ACCOUNT CLERK
Credential:
Phone: 517-768-1636