NPIMap

Organization Active NPI

Jackson Hospital & Clinic, Inc.

Doing business as Jackson Apothecary

  • Pharmacy
  • Montgomery, AL
National Provider Identifier
1467116137
Registry record updated Oct 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
JACKSON HOSPITAL & CLINIC, INC.
Doing business as
Jackson Apothecary
Practice address
1758 Park PL
Montgomery, AL 36106-1127
Phone
(334) 293-8780
NPI assigned
Oct 28, 2021
Last updated
Oct 28, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
JACKSON HOSPITAL & CLINIC, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 28, 2021

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

Authorized official

Name
Richard F Mann
Title
Business Office Director
Phone
(334) 293-8820

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X Primary

Addresses

Primary practice location

1758 Park PL
Montgomery, AL 36106-1127

Mailing address

1758 Park PL
Montgomery, AL 36106-1127
Phone (334) 293-8780

Other names 1

  • Jackson Apothecary Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211223000004 AL Part B Supplier - Pharmacy 0547254153 Practice locations: Montgomery, AL

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

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

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

Locations

1758 Park Pl
Montgomery, AL 36106
Phone (334) 293-8780

1758 Park Pl
Ste 102
Montgomery, AL 36106
Phone (334) 240-1537

Practitioners & affiliated clinicians

Practitioners 2

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": "1635379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635379200000",
    "number": "1467116137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1758 PARK PL",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361061127",
            "telephone_number": "334-293-8780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1758 PARK PL",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361061127",
            "telephone_number": "334-293-8780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON HOSPITAL & CLINIC, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JACKSON HOSPITAL & CLINIC, INC.",
        "enumeration_date": "2021-10-28",
        "last_updated": "2021-10-28",
        "certification_date": "2021-10-08",
        "status": "A",
        "authorized_official_last_name": "MANN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "BUSINESS OFFICE DIRECTOR",
        "authorized_official_telephone_number": "334-293-8820"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Apothecary",
            "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 Oct 28, 2021; 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.