MEDICARE: JACKSON MADISON COUNTY REGIONAL HEALTH DEPARTMENT

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency	TN015749RE	TN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5607	OTHER		ATLC
2	3087941	OTHER	TN	BLUE CROSS-BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1871676593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON MADISON COUNTY REGIONAL HEALTH DEPARTMENT

Provider Business Mailing Address
First Line	:	804 NORTH PARKWAY
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3058
Country	:	US
Telephone Number	:	731-423-3020
Fax Number	:	731-927-8603

Provider Business Practice Location Address
First Line	:	804 NORTH PARKWAY
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3058
Country	:	US
Telephone Number	:	731-423-3020
Fax Number	:	731-927-8603

Authorized Official
Title or Position	:	DIRECTOR
Name	:	TONY R EMISON
Credential	:	MD
Telephone Number	:	731-423-3020

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	08/22/2020

804 N PARKWAY , JACKSON MADISON COUNTY REGIONAL HEALTH DEPT
JACKSON, TN
38305-3058

Practice Phone: 731-423-3020
Practice Fax: 731-927-8600