Provider Demographics
NPI:1043497555
Name:JACKSON COUNTY MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:JACKSON COUNTY MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-243-3581
Mailing Address - Street 1:100 OLD JEFFERSON STREET
Mailing Address - Street 2:PO BOX 427
Mailing Address - City:CELINA
Mailing Address - State:TN
Mailing Address - Zip Code:38551
Mailing Address - Country:US
Mailing Address - Phone:931-243-3581
Mailing Address - Fax:931-243-5291
Practice Address - Street 1:603 S MURRAY ST
Practice Address - Street 2:
Practice Address - City:GAINESBORO
Practice Address - State:TN
Practice Address - Zip Code:38562-9376
Practice Address - Country:US
Practice Address - Phone:931-268-5262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESTORATION HEALTHCARE OF CELINA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-28
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3370326Medicare PIN