NPIMap

Organization Active NPI

Jackson-Madison County General Hospital

  • Clinical Medical Laboratory
  • Jackson, TN
National Provider Identifier
1720160708
Registry record updated Oct 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
44D-0315453 Issued in TN
Legal business name
JACKSON-MADISON COUNTY GENERAL HOSPITAL
Practice address
620 Skyline Drive
Jackson, TN 38301-3901
Phone
(731) 927-7990
Fax
(731) 927-7700
NPI assigned
Oct 19, 2006
Organization subpart
Yes
Parent organization
JACKSON-MADISON COUNTY GENERAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 14, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Tina Prescott
Title
President and Ceo
Phone
(731) 541-5000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 44D-0315453 TN Primary

Addresses

Primary practice location

620 Skyline Drive
Jackson, TN 38301-3901

Mailing address

620 Skyline Drive
Jackson, TN 38301-3901
Phone (731) 927-7990

Other names 1

  • Medical Center Laboratory Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20171102002369 TN Part B Supplier - Ambulance Service Supplier 3678481975 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Selmer, TN; Newbern, TN; Jackson, TN; Henderson, TN; Holladay, TN; Adamsville, TN; Big Sandy, TN; Camden, TN…
O20190131002318 TN Part B Supplier - Independent Clinical Laboratory 3678481975 Practice locations: Jackson, TN

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Jere Hammond MD11 organizations share this tax ID, including this one
Part of
Jere Hammond MD

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 14

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
West Tennessee Healthcare Milan HospitalMilan, TN, CCN 440060 Hospital 5% Or Greater Direct Ownership Interest (100%) Aug 27, 1998
West Tennessee Healthcare Milan HospitalMilan, TN, CCN 44U060 Hospital 5% Or Greater Direct Ownership Interest (5%) Aug 24, 1998
Jackson Madison County General HospitalJackson, TN, CCN 440002 Hospital 5% Or Greater Direct Ownership Interest (100%) Oct 31, 2007
West Tennessee Healthcare Rehabilitation Hospital Jackson, a PartnershJackson, TN, CCN 443036 Hospital 5% Or Greater Direct Ownership Interest (50%) Oct 8, 2015
West Tennessee Healthcare Rehabilitation Hospital Cane Creek, a PartneMartin, TN, CCN 443030 Hospital 5% Or Greater Direct Ownership Interest (50%) Jul 1, 2017
West Tennessee Healthcare Rehabilitation Hospital Cane Creek, a PartneMartin, TN, CCN 44Y030 Hospital 5% Or Greater Direct Ownership Interest (50%) Jul 1, 2017
West Tennessee Healthcare Volunteer HospitalMartin, TN, CCN 440061 Hospital Operational/Managerial Control Jan 2, 2019
West Tennessee Healthcare Dyersburg HospitalDyersburg, TN, CCN 440072 Hospital 5% Or Greater Direct Ownership Interest (50%)
Operational/Managerial Control (50%)		 Jun 1, 2018
Jun 1, 2018
Select Specialty Hospital - West TennesseeJackson, TN, CCN 442018 Hospital 5% Or Greater Direct Ownership Interest (15%) Mar 1, 2023
Extendicare Home Health of Western TennesseeUnion City, TN, CCN 447434 Home health agency 5% Or Greater Indirect Ownership Interest (33%) Oct 1, 2008
Extendicare Home Health of West TennesseeDyersburg, TN, CCN 447284 Home health agency 5% Or Greater Indirect Ownership Interest (33%) Sep 1, 2007
Medical Center Home Health, LLCJackson, TN, CCN 447101 Home health agency 5% Or Greater Indirect Ownership Interest (33%) Oct 1, 2008
Hospice of West TennesseeJackson, TN, CCN 441514 Hospice 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1986
West Tennessee Medical Group Primary Care CaruthersvilleCaruthersville, MO, CCN 793800 Rural health clinic Operational/Managerial Control Jun 1, 2018

Owned or controlled facilities with NPI records 13

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 13

Practitioners & affiliated clinicians

Practitioners 56

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 56

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728864000000",
    "number": "1720160708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 SKYLINE DRIVE",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013901",
            "telephone_number": "731-927-7990",
            "fax_number": "731-927-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 SKYLINE DRIVE",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013901",
            "telephone_number": "731-927-7990",
            "fax_number": "731-927-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON-MADISON COUNTY GENERAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JACKSON-MADISON COUNTY GENERAL HOSPITAL",
        "enumeration_date": "2006-10-19",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-14",
        "status": "A",
        "authorized_official_last_name": "PRESCOTT",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "731-541-5000",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "TN",
            "license": "44D-0315453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Center Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, TN

Sources for this page

Verify at the official NPI Registry.