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Contact Information

JACK COUNTY HOSPITAL DISTRICT
215 CHISHOLM TRL
JACKSBORO, TX76458
 Phone: 940-567-6633
 Fax: 940-567-2895
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Acute Care Hospital

282N00000X A0[7] Hospital-General
 

Family Medicine

207Q00000X 08 Physician/Family Practice
 

Nurse Anesthetist, Certified Registered

367500000X 43 Certified Registered Nurse Anesthetist (CRNA)
Indicates primary specialty

NPI Profile & details for JACK COUNTY HOSPITAL DISTRICT

NPI Number 1790777696
LBN Legal business name JACK COUNTY HOSPITAL DISTRICT
Authorized official KIM LEE - (COO)
Entity Organization
Organization subpart 1 No
Enumeration date 08/17/2005
Last updated 09/16/2021 - About 5 years ago
Identifiers
TX License # 000046
TX License # 100322
TX Medicaid 119874902
TX Medicaid 119874903
TX Medicaid 119874904
TX Medicaid 119874905
TX Other HH0054 BC/BS PROVIDER NUMBER
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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