Provider Demographics
NPI:1659934305
Name:COUNTY OF JACKSON
Entity Type:Organization
Organization Name:COUNTY OF JACKSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-631-2249
Mailing Address - Street 1:401 GRINDSTAFF COVE RD
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-3250
Mailing Address - Country:US
Mailing Address - Phone:828-631-2249
Mailing Address - Fax:828-586-7506
Practice Address - Street 1:154 MEDICAL PARK LOOP
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5271
Practice Address - Country:US
Practice Address - Phone:828-631-2249
Practice Address - Fax:828-586-7506
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF JACKSON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
349353OtherBCBSNC