NPIMap

Organization Active NPI

Jackson Hospital & Clinic, Inc.

Doing business as Jackson Clinic OBGYN Tallassee

  • Obstetrics & Gynecology Physician
  • Tallassee, AL
National Provider Identifier
1235667544
Registry record updated Mar 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
JACKSON HOSPITAL & CLINIC, INC.
Doing business as
Jackson Clinic OBGYN Tallassee
Practice address
80 Herren Hill Rd Ste C
Tallassee, AL 36078-1264
Phone
(334) 284-1500
Fax
(334) 288-7763
NPI assigned
May 31, 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
Obstetrics & Gynecology Physician 207V00000X Primary

Addresses

Primary practice location

80 Herren Hill Rd Ste C
Tallassee, AL 36078-1264

Mailing address

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

Other names 1

  • Jackson Clinic OBGYN Tallassee 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

NPI Registry JSON

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

{
    "created_epoch": "1496188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773014400000",
    "number": "1235667544",
    "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": "80 HERREN HILL RD STE C",
            "city": "TALLASSEE",
            "state": "AL",
            "postal_code": "360781264",
            "telephone_number": "334-284-1500",
            "fax_number": "334-288-7763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON HOSPITAL & CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-31",
        "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": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Clinic OBGYN Tallassee",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tallassee, 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.