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General NPI Number Information
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NPI Number | 1336237890
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Entity Type | Organization
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Legal Business Name | JACK COUNTY HOSPITAL DISTRICT
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 12/22/2011
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Provider Practice Location Address
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Address Line | 717 MAGNOLIA ST
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City | JACKSBORO
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State | TX
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Zip | 76458-1111
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Country | US
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Telephone | 940-567-6633
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Fax | 940-567-3975
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Provider Business Mailing Address
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Address Line | PO BOX 290184
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City | WETHERSFIELD
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State | CT
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Zip | 06129-0184
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Country | US
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Telephone | 860-257-7080
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Fax | 860-563-3403
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Authorized Official
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Title or Position | AUTHORIZED AGENT
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Name | MRS. MARY T GENTILE
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Credential |
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Telephone | 860-257-7080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 119004
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License Number State | TX
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