ER Physician Group at Jackson Hospital

Primary specialty

SpecialistTaxonomy code 174400000X

License

ME78684 AND ME93313 Issued in FL

Legal business name

ER PHYSICIAN GROUP AT JACKSON HOSPITAL

Doing business as

Womens Healthcare of The Panhandle

Practice address

4298 5TH Ave
Marianna, FL 32446-2173

Phone

(850) 482-5787

Fax

(850) 482-8108

NPI assigned

Jun 5, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Belinda Hidle

Title

Compliance Officer

Phone

(850) 718-2644

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Womens Healthcare of The Panhandle Doing business as

Tax ID family

ER Phy GRP at Jackson H3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• ER Physician Group at Jackson Hospital

  • Multi-Specialty Clinic/Center
  • Alford, FL
  • NPI 1356917892
  NPD tax ID
• ER Physician Group at Jackson Hospital

  • Specialist
  • Marianna, FL
  • NPI 1790732881
  NPD tax ID

Locations

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215043200000",
    "number": "1407895584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4298 5TH AVE",
            "city": "MARIANNA",
            "state": "FL",
            "postal_code": "324462173",
            "telephone_number": "850-482-5787",
            "fax_number": "850-482-8108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4298 5TH AVE",
            "city": "MARIANNA",
            "state": "FL",
            "postal_code": "324462173",
            "telephone_number": "850-482-5787",
            "fax_number": "850-482-8108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ER PHYSICIAN GROUP AT JACKSON HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-05",
        "last_updated": "2008-07-03",
        "status": "A",
        "authorized_official_last_name": "HIDLE",
        "authorized_official_first_name": "BELINDA",
        "authorized_official_title_or_position": "COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "850-718-2644",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME78684 AND ME93313",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "054877400",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "270213400",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "38679",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE FIRST COAST",
            "identifier": "0142",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "272901600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Womens Healthcare of The Panhandle",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Emerald Coast Management Solutions LLC
• Emerald Coast Neonatology PA
• Eminence Emergency Physicians, LLC
• Endless Empowerment, PLLC
• ER Physician Group at Jackson Hospital
• ER Physician Group at Jackson Hospital
• ER Physicians Group at Jackson Hospital
• Everest Medical Care P a
• Eye Partners PC
• Arlena C. Falcon, ARNP-C

• Specialist in Marianna, FL
• Providers in Marianna, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2008; 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.