Provider Demographics
NPI:1639133028
Name:JACKSON COUNTY PUBLIC HOSPITAL
Entity Type:Organization
Organization Name:JACKSON COUNTY PUBLIC HOSPITAL
Other - Org Name:JACKSON CO REGIONAL HEALTH CENTER HOME & COMMUNITY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CURT
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-652-4020
Mailing Address - Street 1:700 W GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MAQUOKETA
Mailing Address - State:IA
Mailing Address - Zip Code:52060-2163
Mailing Address - Country:US
Mailing Address - Phone:563-652-2474
Mailing Address - Fax:563-652-4096
Practice Address - Street 1:700 W GROVE ST
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-2163
Practice Address - Country:US
Practice Address - Phone:563-652-2474
Practice Address - Fax:563-652-4096
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACKSON COUNTY PUBLIC HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-13
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA490099H251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0671230Medicaid
IA0671230Medicaid