Organization
JACK COUNTY HOSPITAL DISTRICT
Active
Other names
FAITH COMMUNITY HOSPITAL
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIM LEE (COO)
(940) 567-6633
Entity
Organization
Contact information
Practice address
215 CHISHOLM TRL, JACKSBORO, TX 76458
(940) 567-6633
(940) 567-2895
Mailing address
215 CHISHOLM TRL, JACKSBORO, TX 76458-1403
(940) 567-6633
(940) 567-2895
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
TX
282N00000X
General Acute Care Hospital
000046
TX
282N00000X
General Acute Care Hospital
Primary
100322
TX
367500000X
Certified Registered Nurse Anesthetist
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119874902
—
TX
05
—
119874903
—
TX
05
—
119874904
—
TX
05
—
119874905
—
TX
01
—
HH0054
BC/BS PROVIDER NUMBER
TX
Enumeration date
08/17/2005
Last updated
09/16/2021
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