Provider Demographics
NPI:1053011791
Name:JACKSON MADISON COUNTY GENERAL HOSPITAL
Entity type:Organization
Organization Name:JACKSON MADISON COUNTY GENERAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUITVE DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:731-541-6229
Mailing Address - Street 1:367 HOSPITAL BOULEVARD
Mailing Address - Street 2:1ST FLOOR SUITE 101
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2080
Mailing Address - Country:US
Mailing Address - Phone:731-661-2260
Mailing Address - Fax:731-661-2261
Practice Address - Street 1:367 HOSPITAL BOULEVARD
Practice Address - Street 2:1ST FLOOR SUITE 101
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2080
Practice Address - Country:US
Practice Address - Phone:731-661-2260
Practice Address - Fax:731-661-2261
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACKSON MADISON COUNTY GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-09
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy