Healthcare Provider Details

I. General information

NPI: 1831674209
Provider Name (Legal Business Name): JACK COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E BYPASS 287
ALVORD TX
76225-7778
US

IV. Provider business mailing address

215 CHISHOLM TRL
JACKSBORO TX
76458-1403
US

V. Phone/Fax

Practice location:
  • Phone: 940-427-2858
  • Fax:
Mailing address:
  • Phone: 940-216-2262
  • Fax: 940-567-2895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAWN JONES
Title or Position: FISCAL SERVICES DIRECTOR
Credential:
Phone: 940-216-2262