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General NPI Number Information
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NPI Number | 1639133028
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Entity Type | Organization
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Legal Business Name | JACKSON COUNTY PUBLIC HOSPITAL
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 06/11/2012
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Provider Practice Location Address
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Address Line | 700 W GROVE ST
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City | MAQUOKETA
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State | IA
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Zip | 52060-2163
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Country | US
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Telephone | 563-652-2474
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Fax | 563-652-4096
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Provider Business Mailing Address
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Address Line | 700 W GROVE ST
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City | MAQUOKETA
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State | IA
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Zip | 52060-2163
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Country | US
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Telephone | 563-652-2474
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Fax | 563-652-4096
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Authorized Official
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Title or Position | CEO
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Name | CURT M COLEMAN
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Credential |
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Telephone | 563-652-4020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 490099H
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License Number State | IA
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