Provider Demographics
NPI: | 1437174216 |
---|---|
Name: | JACKSON MADISON COUNTY GENERAL HOSPITAL |
Entity Type: | Organization |
Organization Name: | JACKSON MADISON COUNTY GENERAL HOSPITAL |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR OF PHYSICIAN BILLING |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JAMA |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | PHILLIPS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 731-512-1510 |
Mailing Address - Street 1: | 1804 HIGHWAY 45 BYP |
Mailing Address - Street 2: | SUITE 604 |
Mailing Address - City: | JACKSON |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 38305-4436 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 731-660-8759 |
Mailing Address - Fax: | 731-660-8739 |
Practice Address - Street 1: | 708 W FOREST AVE |
Practice Address - Street 2: | |
Practice Address - City: | JACKSON |
Practice Address - State: | TN |
Practice Address - Zip Code: | 38301-3901 |
Practice Address - Country: | US |
Practice Address - Phone: | 731-660-8759 |
Practice Address - Fax: | 731-660-8739 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | JACKSON MADISON COUNTY GENERAL HOSPITAL |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-07-13 |
Last Update Date: | 2008-05-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Multi-Specialty |
No | 207ZB0001X | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine | Group - Multi-Specialty |
No | 207ZC0500X | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | Group - Multi-Specialty |
No | 207ZD0900X | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | Group - Multi-Specialty |
No | 207ZH0000X | Allopathic & Osteopathic Physicians | Pathology | Hematology | Group - Multi-Specialty |
No | 207ZI0100X | Allopathic & Osteopathic Physicians | Pathology | Immunopathology | Group - Multi-Specialty |
No | 207ZM0300X | Allopathic & Osteopathic Physicians | Pathology | Medical Microbiology | Group - Multi-Specialty |
No | 207ZN0500X | Allopathic & Osteopathic Physicians | Pathology | Neuropathology | Group - Multi-Specialty |
No | 207ZP0007X | Allopathic & Osteopathic Physicians | Pathology | Molecular Genetic Pathology | Group - Multi-Specialty |
No | 207ZP0213X | Allopathic & Osteopathic Physicians | Pathology | Pediatric Pathology | Group - Multi-Specialty |
No | 2080N0001X | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | Group - Multi-Specialty |
No | 2080P0203X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TN | 3277946 | Medicaid | |
TN | 3277946 | Medicaid |