1043409311 NPI number — JACKSON HOSPITAL AND CLINIC, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043409311 NPI number — JACKSON HOSPITAL AND CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JACKSON HOSPITAL AND CLINIC, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043409311
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2257 TAYLOR RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36117-7790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-270-9914
Provider Business Mailing Address Fax Number:
334-270-3195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 PINE ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36106-0165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-240-2334
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHOLL
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
334-293-8000

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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