Provider Demographics
NPI:1720311475
Name:JACKSON COUNTY PUBLIC HEALTH
Entity Type:Organization
Organization Name:JACKSON COUNTY PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-284-4301
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:420 HWY 54 WEST
Mailing Address - City:BLACK RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54615-0457
Mailing Address - Country:US
Mailing Address - Phone:715-284-4301
Mailing Address - Fax:715-284-7713
Practice Address - Street 1:420 HWY 54 WEST
Practice Address - Street 2:
Practice Address - City:BLACK RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54615-0457
Practice Address - Country:US
Practice Address - Phone:715-284-4301
Practice Address - Fax:715-284-7713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41858500Medicaid