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NPI Code Detail

MEDICARE: JACKSON HOSPITAL DME

MEDICARE: JACKSON HOSPITAL DME
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1689975583
Entity Type Code : Organization
Provider Name (Legal Business Name) : JACKSON HOSPITAL DME
Provider Business Mailing Address
First Line : 4250 HOSPITAL DR
Second Line :
City : MARIANNA
State : FL
Zip : 32446-1917
Country : US
Telephone Number : 850-526-2200
Fax Number : 850-718-2894
Provider Business Practice Location Address
First Line : 4295 3RD AVE
Second Line :
City : MARIANNA
State : FL
Zip : 32446-2120
Country : US
Telephone Number : 850-482-0017
Fax Number : 850-482-0018
Authorized Official
Title or Position : ADMINISTRATOR
Name : LAWRENCE R MEESE JR.
Credential : CEO
Telephone Number : 850-526-2200
Provider Enumeration Date : 11/09/2010
Last Update Date : 08/29/2012

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Directions to “JACKSON HOSPITAL DME ” Practice Location

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