# JACK COUNTY HOSPITAL DISTRICT

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- **Entity:** Organization
- **Status:** Active
- **Other names:** FAITH COMMUNITY HOSPITAL
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790777696
- **Authorized official:** MRS. KIM LEE (COO)
- **Authorized official phone:** (940) 567-6633

## Contact information

- **Practice address:** 215 CHISHOLM TRL, JACKSBORO, TX 76458
- **Practice address phone:** (940) 567-6633
- **Practice address fax:** (940) 567-2895
- **Mailing address:** 215 CHISHOLM TRL, JACKSBORO, TX 76458-1403
- **Mailing address phone:** (940) 567-6633
- **Mailing address fax:** (940) 567-2895

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | TX | — |
| 282N00000X | General Acute Care Hospital | 000046 | TX | — |
| 282N00000X | General Acute Care Hospital | 100322 | TX | Yes |
| 367500000X | Certified Registered Nurse Anesthetist | — | TX | — |

## Other

- **Enumeration date:** 08/17/2005
- **Last updated:** 09/16/2021