Provider Demographics
NPI:1952306672
Name:MOTHER FRANCES HOSPITAL JACKSONVILLE
Entity Type:Organization
Organization Name:MOTHER FRANCES HOSPITAL JACKSONVILLE
Other - Org Name:CHRISTUS MOTHER FRANCES HOSPITAL - JACKSONVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER ENROLLMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-606-6425
Mailing Address - Street 1:PO BOX 847522
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7522
Mailing Address - Country:US
Mailing Address - Phone:903-541-4500
Mailing Address - Fax:903-541-4679
Practice Address - Street 1:2026 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-5822
Practice Address - Country:US
Practice Address - Phone:903-541-4500
Practice Address - Fax:903-541-4679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007254282NC0060X
367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141858401Medicaid
TX165773601Medicaid
TX199777701Medicaid
TX141858403Medicaid
TX165773602Medicaid
TXHH0993OtherBLUE CROSS
TX141858403Medicaid
TX199777701Medicaid
TX00Z794Medicare Oscar/Certification