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General NPI Number Information
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NPI Number | 1790777696
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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 | 08/17/2005
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Last Update Date | 09/16/2021
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Provider Practice Location Address
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Address Line | 215 CHISHOLM TRL
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City | JACKSBORO
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State | TX
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Zip | 76458
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Country | US
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Telephone | 940-567-6633
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Fax | 940-567-2895
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Provider Business Mailing Address
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Address Line | 215 CHISHOLM TRL
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City | JACKSBORO
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State | TX
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Zip | 76458-1403
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Country | US
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Telephone | 940-567-6633
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Fax | 940-567-2895
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Authorized Official
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Title or Position | COO
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Name | MRS. KIM LEE
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Credential |
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Telephone | 940-567-6633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 000046
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 100322
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License Number State | TX
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