Healthcare Provider Details

I. General information

NPI: 1992748693
Provider Name (Legal Business Name): JACKSON COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013A SOUTH WELLS STREET
EDNA TX
77957-4045
US

IV. Provider business mailing address

1013 S WELLS STREET
EDNA TX
77957-4098
US

V. Phone/Fax

Practice location:
  • Phone: 361-782-3560
  • Fax: 361-782-5627
Mailing address:
  • Phone: 361-782-7800
  • Fax: 361-782-7495

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: LANCE HARRISON SMIGA
Title or Position: ADMINISTRATOR/CFO
Credential:
Phone: 361-782-7800