Healthcare Provider Details

I. General information

NPI: 1053011791
Provider Name (Legal Business Name): JACKSON MADISON COUNTY GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367 HOSPITAL BOULEVARD 1ST FLOOR SUITE 101
JACKSON TN
38305-2080
US

IV. Provider business mailing address

367 HOSPITAL BLVD
JACKSON TN
38305-2080
US

V. Phone/Fax

Practice location:
  • Phone: 731-661-2260
  • Fax: 731-661-2261
Mailing address:
  • Phone: 731-661-2260
  • Fax: 731-661-2261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: WILLIAM MCMINN
Title or Position: EXECUITVE DIRECTOR OF PHARMACY
Credential:
Phone: 731-541-6229