Provider Demographics
NPI:1881815520
Name:JACKSON COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:JACKSON COUNTY HOSPITAL DISTRICT
Other - Org Name:CHIPOLA SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:VECHAI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ARUNAKUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-718-2644
Mailing Address - Street 1:3051 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-1933
Mailing Address - Country:US
Mailing Address - Phone:850-718-2644
Mailing Address - Fax:850-718-2894
Practice Address - Street 1:3051 6TH ST
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-1933
Practice Address - Country:US
Practice Address - Phone:850-718-2644
Practice Address - Fax:850-718-2894
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACKSON COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-01
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98090174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1811915580OtherNPI
FL95017OtherBCBSFL
FLME98090OtherFLME
FLME98090OtherFLME