Healthcare Provider Details

I. General information

NPI: 1043497555
Provider Name (Legal Business Name): JACKSON COUNTY MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 S MURRAY ST
GAINESBORO TN
38562-9376
US

IV. Provider business mailing address

100 OLD JEFFERSON STREET PO BOX 427
CELINA TN
38551
US

V. Phone/Fax

Practice location:
  • Phone: 931-268-5262
  • Fax:
Mailing address:
  • Phone: 931-243-3581
  • Fax: 931-243-5291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number15
License Number StateTN

VIII. Authorized Official

Name: MRS. TRICIA L STRONG
Title or Position: CFO
Credential:
Phone: 931-243-3581