Provider Demographics
NPI:1831198373
Name:JONESTOWN HEALTH CENTER
Entity type:Organization
Organization Name:JONESTOWN HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:GORETTI
Authorized Official - Middle Name:
Authorized Official - Last Name:GERMAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-358-4377
Mailing Address - Street 1:PO BOX 79
Mailing Address - Street 2:
Mailing Address - City:JONESTOWN
Mailing Address - State:MS
Mailing Address - Zip Code:38639-0079
Mailing Address - Country:US
Mailing Address - Phone:662-358-4377
Mailing Address - Fax:662-358-4371
Practice Address - Street 1:280 SECOND STREET
Practice Address - Street 2:
Practice Address - City:JONESTOWN
Practice Address - State:MS
Practice Address - Zip Code:38639-0079
Practice Address - Country:US
Practice Address - Phone:662-358-4377
Practice Address - Fax:662-358-4371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09010087Medicaid
MS09010087Medicaid