Provider Demographics
NPI:1285677401
Name:JACKSON COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:JACKSON COUNTY HOSPITAL DISTRICT
Other - Org Name:JACKSON COUNTY HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SATROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-782-5241
Mailing Address - Street 1:1013 S WELLS ST
Mailing Address - Street 2:
Mailing Address - City:EDNA
Mailing Address - State:TX
Mailing Address - Zip Code:77957-4045
Mailing Address - Country:US
Mailing Address - Phone:361-782-7830
Mailing Address - Fax:361-781-0812
Practice Address - Street 1:918 SOUTH WELLS STREET
Practice Address - Street 2:
Practice Address - City:EDNA
Practice Address - State:TX
Practice Address - Zip Code:77957-3745
Practice Address - Country:US
Practice Address - Phone:361-782-7830
Practice Address - Fax:361-781-0812
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACKSON COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111714502Medicaid
TX111714502Medicaid
TX677103Medicare PIN