NPIMap

Organization Active NPI

Jackson Hospital and Clinic Inc.

Doing business as Jackson Clinic Cardiology Suite 402

  • Cardiovascular Disease Physician
  • Montgomery, AL
National Provider Identifier
1194261669
Registry record updated Mar 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
JACKSON HOSPITAL AND CLINIC INC.
Doing business as
Jackson Clinic Cardiology Suite 402
Practice address
1758 Park PL
Suite 402
Montgomery, AL 36106-1127
Phone
(334) 293-6842
Fax
(334) 293-6843
NPI assigned
Jan 9, 2017
Last updated
Mar 9, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2026

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

Authorized official

Name
Kelin Penney
Title
Executive Director
Phone
(334) 240-2335

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X NU Primary

Addresses

Primary practice location

1758 Park PL
Suite 402
Montgomery, AL 36106-1127

Mailing address

1722 Pine St Ste 804
Montgomery, AL 36106-1108
Phone (334) 240-2337

Other names 1

  • Jackson Clinic Cardiology Suite 402 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040414000971 AL Part B Supplier - Clinic/Group Practice 0547254153 Receives reassigned benefits from 247 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Aeras71 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1483920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773014400000",
    "number": "1194261669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1722 PINE ST STE 804",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361061108",
            "telephone_number": "334-240-2337",
            "fax_number": "334-293-8738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1758 PARK PL",
            "address_2": "SUITE 402",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361061127",
            "telephone_number": "334-293-6842",
            "fax_number": "334-293-6843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON HOSPITAL AND CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-09",
        "last_updated": "2026-03-09",
        "certification_date": "2026-03-09",
        "status": "A",
        "authorized_official_last_name": "PENNEY",
        "authorized_official_first_name": "KELIN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "334-240-2335"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Clinic Cardiology Suite 402",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Montgomery, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.