Healthcare Provider Details

I. General information

NPI: 1205239266
Provider Name (Legal Business Name): JACK COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N MAIN ST
COLLINSVILLE TX
76233-5106
US

IV. Provider business mailing address

215 CHISHOLM TRL
JACKSBORO TX
76458-1403
US

V. Phone/Fax

Practice location:
  • Phone: 903-429-6426
  • Fax: 903-429-6240
Mailing address:
  • Phone: 940-567-6633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

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