Healthcare Provider Details

I. General information

NPI: 1275614794
Provider Name (Legal Business Name): JACKSON COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 S WELLS ST
EDNA TX
77957-4098
US

IV. Provider business mailing address

1013 S WELLS ST
EDNA TX
77957-4098
US

V. Phone/Fax

Practice location:
  • Phone: 361-782-5241
  • Fax: 361-782-7495
Mailing address:
  • Phone: 361-782-5241
  • Fax: 361-782-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARCELLA VANA HENKE
Title or Position: ADMINISTRATOR/CEO
Credential:
Phone: 361-782-5241