Provider Demographics
NPI:1306046131
Name:JACKSON HOSPITAL
Entity Type:Organization
Organization Name:JACKSON HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD OF THE EMERGENCY DEPARTMENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:1
Authorized Official - Last Name:DISKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-585-1100
Mailing Address - Street 1:10730 SW 30TH PL
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-1536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10730 SW 30TH PL
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-1536
Practice Address - Country:US
Practice Address - Phone:305-585-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1542872282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access