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Organization
JACKSON COUNTY HOSPITAL DISTRICT
Active
Organization
JACKSON COUNTY HOSPITAL DISTRICT
Active
Other names
Jackson Medical Clinic Physican Group
Organization subpart
No
Provider details
NPI number
Authorized official
ASA B WILSON (ADMINSITRATOR/CEO)
(361) 782-7810
Entity
Organization
Contact information
Practice address
1013 S WELLS ST, EDNA, TX 77957-4098
(361) 782-7800
(361) 782-7495
Mailing address
1013 S WELLS ST, EDNA, TX 77957-4098
(361) 782-7800
(361) 782-7495
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00U54J
BLUE CROSS
TX
05
—
111714501
—
TX
Enumeration date
10/17/2006
Last updated
10/15/2009
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