=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912918277
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAY HOSPITAL, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2006
-----------------------------------------------------
Last Update Date | 03/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14114 ALABAMA ST
-----------------------------------------------------
City | JAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32565-1219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-675-8015
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14114 ALABAMA ST
-----------------------------------------------------
City | JAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32565-1219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-675-8015
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONTROLLER
-----------------------------------------------------
Name | KEITH STRICKLING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 850-675-8024
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------