Provider Demographics
NPI:1417293846
Name:JACKSON HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:JACKSON HOSPITAL CORPORATION
Other - Org Name:CAMPTON RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PATIENT FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:P
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-221-3672
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:800-709-7338
Mailing Address - Fax:615-469-6505
Practice Address - Street 1:49 KY 15 N
Practice Address - Street 2:
Practice Address - City:CAMPTON
Practice Address - State:KY
Practice Address - Zip Code:41301-7284
Practice Address - Country:US
Practice Address - Phone:606-668-9841
Practice Address - Fax:606-668-7730
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACKSON HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-12
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100620261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY183482Medicare Oscar/Certification