Provider Demographics
NPI:1689705949
Name:JACKSON COUNTY PUBLIC HOSPITAL
Entity Type:Organization
Organization Name:JACKSON COUNTY PUBLIC HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CURT
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-652-2474
Mailing Address - Street 1:601 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:MAQUOKETA
Mailing Address - State:IA
Mailing Address - Zip Code:52060-0910
Mailing Address - Country:US
Mailing Address - Phone:563-652-2474
Mailing Address - Fax:563-652-4096
Practice Address - Street 1:601 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-0910
Practice Address - Country:US
Practice Address - Phone:563-652-2474
Practice Address - Fax:563-652-4096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA490099H207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0119263Medicaid
IA0119263Medicaid