Provider Demographics
NPI:1043213283
Name:JEFFERSON COUNTY
Entity Type:Organization
Organization Name:JEFFERSON COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:B
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, MPH
Authorized Official - Phone:315-786-3715
Mailing Address - Street 1:531 MEADE ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-1225
Mailing Address - Country:US
Mailing Address - Phone:315-786-3770
Mailing Address - Fax:315-786-3761
Practice Address - Street 1:531 MEADE ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-1225
Practice Address - Country:US
Practice Address - Phone:315-786-3770
Practice Address - Fax:315-786-3761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2201600251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00895487Medicaid
NY00583615Medicaid
NY00583615Medicaid