Jackson Hospital and Clinic, Inc.
Organization Active NPI Obstetrics Physician · Montgomery, AL
NPI 1477029072 · NPPES record last updated Oct 22, 2018
Key facts
- NPI
- 1477029072
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Obstetrics Physician 207VX0000X
- Legal business name
- JACKSON HOSPITAL AND CLINIC, INC.
- Practice address
- 1722 Pine St Ste 603
Montgomery, AL 36106-1114 - Phone
- (334) 264-2422
- Fax
- (334) 264-9294
- NPI assigned
- Oct 22, 2018
- Organization subpart
- No
Authorized official
- Name
- Tara Herring
- Title
- Revenue Cycle Director
- Phone
- (334) 240-2337
Corporate family (same tax ID) 24
Practitioners 3
-
Rebecca Alexander, CRNP
-
Glenn J Saucer, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
- Tax ID family
- Egidio G Delfabbro
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics Physician |
207VX0000X | Yes |
Addresses
Primary practice location
1722 Pine St Ste 603
Montgomery, AL 36106-1114
Mailing address
1722 Pine St Ste 503
Montgomery, AL 36106-1160
Phone (334) 293-8736
Other names
- Jackson OBGYN Dr. Glenn Saucer
Other providers in Montgomery, AL
- Jackson Hospital and Clinic, Inc
- Jackson Hospital and Clinic, Inc
- Jackson Hospital and Clinic, Inc.
- Jackson Hospital and Clinic, Inc.
- Jackson Hospital and Clinic, Inc.
- Jackson Hospital and Clinic, Inc.
- Jackson Hospital and Clinic, Inc.
- Jackson Hospital and Clinic, Inc.
- Jackson Hospital and Clinic, Inc.
- Jackson Hospital and Clinic, Inc.
All providers in Montgomery, AL · Obstetrics Physician in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 22, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.