NPIMap

Organization Active NPI

Internal Medicine Associates of Jackson Hospital

  • Rural Health Clinic/Center
  • Marianna, FL
National Provider Identifier
1427475185
Registry record updated May 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
3999 Issued in FL
Legal business name
INTERNAL MEDICINE ASSOCIATES OF JACKSON HOSPITAL
Practice address
4318 5TH Ave
Marianna, FL 32446-2182
Phone
(850) 526-5300
Fax
(850) 482-5021
NPI assigned
Mar 19, 2014
Organization subpart
Yes
Parent organization
JACKSON COUNTY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 14, 2014

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

Authorized official

Name
Bonnie Hart
Title
PT Financial Specialist
Phone
(850) 526-5300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 3999 FL Primary

Addresses

Primary practice location

4318 5TH Ave
Marianna, FL 32446-2182

Mailing address

4318 5TH Ave
Marianna, FL 32446-2182
Phone (850) 526-5300

Other identifiers 2

IdentifierTypeStateIssuer
W42OtherFLBCBS
660233900MedicaidFL

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.

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": "1395187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400025600000",
    "number": "1427475185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4318 5TH AVE",
            "city": "MARIANNA",
            "state": "FL",
            "postal_code": "324462182",
            "telephone_number": "850-526-5300",
            "fax_number": "850-482-5021"
        },
        {
            "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": "850-482-5021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE ASSOCIATES OF JACKSON HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JACKSON COUNTY HOSPITAL",
        "enumeration_date": "2014-03-19",
        "last_updated": "2014-05-14",
        "status": "A",
        "authorized_official_last_name": "HART",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_title_or_position": "PT FINANCIAL SPECIALIST",
        "authorized_official_telephone_number": "850-526-5300"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "FL",
            "license": "3999",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "W42",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "660233900",
            "state": "FL"
        }
    ],
    "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 May 14, 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.