Provider Demographics
NPI:1871676593
Name:JACKSON MADISON COUNTY REGIONAL HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:JACKSON MADISON COUNTY REGIONAL HEALTH DEPARTMENT
Other - Org Name:JACKSON MADISON COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:R
Authorized Official - Last Name:EMISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-423-3020
Mailing Address - Street 1:804 NORTH PARKWAY
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3058
Mailing Address - Country:US
Mailing Address - Phone:731-423-3020
Mailing Address - Fax:731-927-8603
Practice Address - Street 1:804 NORTH PARKWAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3058
Practice Address - Country:US
Practice Address - Phone:731-423-3020
Practice Address - Fax:731-927-8603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN015749RE251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
5607OtherATLC
TN3087941OtherBLUE CROSS-BLUE SHIELD
TN4448133Medicaid
5607OtherATLC
TNP00276040Medicare ID - Type UnspecifiedRAILROAD
TN3914083Medicare ID - Type Unspecified
5607OtherATLC