NPIMap

Organization Active NPI

Jackson County Hospital District

  • Rural Health Clinic/Center
  • Marianna, FL
National Provider Identifier
1083035232
Registry record updated Aug 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
JACKSON COUNTY HOSPITAL DISTRICT
Doing business as
INTERNAL MEDICINE ASSOCIATES OF JACKSON HOSPITAL
Practice address
4318 5TH Ave
Marianna, FL 32446-2182
Phone
(850) 526-5300
Fax
(850) 428-5021
NPI assigned
Dec 13, 2013
Organization subpart
Yes
Parent organization
JACKSON COUNTY HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 23, 2021

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

Authorized official

Name
Mrs. Kelly Connolly
Title
Cfo
Phone
(850) 718-2623

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

4318 5TH Ave
Marianna, FL 32446-2182

Mailing address

4250 Hospital Dr
Marianna, FL 32446-1917
Phone (850) 526-2200

Other identifiers 2

IdentifierTypeStateIssuer
660233900MedicaidFL
W42OtherFLBCBS

Other names 1

  • INTERNAL MEDICINE ASSOCIATES OF JACKSON HOSPITAL Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Jackson Hospital6 organizations share this tax ID, including this one
Part of
Jackson Hospital

Other organizations with this tax ID 5

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

Locations

4318 5th Ave
Marianna, FL 32446
Phone (850) 209-8831

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1386892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629676800000",
    "number": "1083035232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4250 HOSPITAL DR",
            "city": "MARIANNA",
            "state": "FL",
            "postal_code": "324461917",
            "telephone_number": "850-526-2200",
            "fax_number": "850-718-2844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4318 5TH AVE",
            "city": "MARIANNA",
            "state": "FL",
            "postal_code": "324462182",
            "telephone_number": "850-526-5300",
            "fax_number": "850-428-5021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JACKSON COUNTY HOSPITAL DISTRICT",
        "enumeration_date": "2013-12-13",
        "last_updated": "2021-08-23",
        "certification_date": "2021-07-29",
        "status": "A",
        "authorized_official_last_name": "CONNOLLY",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "850-718-2623",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "660233900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "W42",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "INTERNAL MEDICINE ASSOCIATES OF JACKSON HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "INTERNAL MEDICINE ASSOCIATES OF JACKSON HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marianna, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.