Organization
JACKSON COUNTY HOSPITAL DISTRICT
Active
Other names
Jackson Medical Clinic of Ganado Physician Group
Organization subpart
No
Provider details
NPI number
Authorized official
MARCELLA VANA HENKE (ADMINISTRATOR/CEO)
(361) 782-5241
Entity
Organization
Contact information
Practice address
202 S. THIRD STREET, GANADO, TX 77962-1214
(361) 771-3571
(361) 771-3574
Mailing address
1013 S WELLS ST, EDNA, TX 77957-4098
(361) 782-5241
(361) 782-7495
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
85627001
—
TX
Enumeration date
10/23/2006
Last updated
09/11/2025
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