NPIMap

Organization Active NPI

ER Physicians Group at Jackson Hospital

  • Pediatrics Physician
  • Marianna, FL
National Provider Identifier
1215347414
Registry record updated Apr 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
5101019459 Issued in MI
Legal business name
ER PHYSICIANS GROUP AT JACKSON HOSPITAL
Practice address
436 3Rd Ave
Suite a
Marianna, FL 32446
Phone
(850) 718-2677
NPI assigned
Apr 28, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2014

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

Authorized official

Name
Melissa Sue Moniz
Title
Director of Physician Practices
Phone
(850) 718-2677

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X 5101019459 MI Primary

Addresses

Primary practice location

436 3Rd Ave
Suite a
Marianna, FL 32446

Mailing address

4250 Hospital Dr
Marianna, FL 32446-1917
Phone (850) 718-2677

National Provider Directory

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

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1398643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398643200000",
    "number": "1215347414",
    "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": "850-718-2677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "436 3RD AVE",
            "address_2": "SUITE A",
            "city": "MARIANNA",
            "state": "FL",
            "postal_code": "32446",
            "telephone_number": "850-718-2677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ER PHYSICIANS GROUP AT JACKSON HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-28",
        "last_updated": "2014-04-28",
        "status": "A",
        "authorized_official_last_name": "MONIZ",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "DIRECTOR OF PHYSICIAN PRACTICES",
        "authorized_official_telephone_number": "850-718-2677"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "5101019459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Apr 28, 2014; 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.