NPIMap

Organization Active NPI

Jackson Hospital and Clinic, Inc

  • Family Medicine Physician
  • Montgomery, AL
National Provider Identifier
1497362172
Registry record updated Sep 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
JACKSON HOSPITAL AND CLINIC, INC
Practice address
4035 Atlanta Hwy
Montgomery, AL 36109-2920
Phone
(334) 603-8708
Fax
(334) 603-8709
NPI assigned
Sep 28, 2020
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Tara Herring
Title
Revenue Cycle Director
Phone
(334) 240-2337

Corporate family (same tax ID) 24

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

National Provider Directory

National Provider Directory
Tax ID family
Egidio G Delfabbro (71 organizations share this tax ID)

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

4035 Atlanta Hwy
Montgomery, AL 36109-2920

Mailing address

1722 Pine St Ste 203
Montgomery, AL 36106-1158
Phone (334) 293-8736

Other names 1

NPPES NPI Registry
  • Jackson Family Medicine Dalraida Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 28, 2020.

{
    "created_epoch": "1601251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601251200000",
    "number": "1497362172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1722 PINE ST STE 203",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361061158",
            "telephone_number": "334-293-8736",
            "fax_number": "334-293-8738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4035 ATLANTA HWY",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361092920",
            "telephone_number": "334-603-8708",
            "fax_number": "334-603-8709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON HOSPITAL AND CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-28",
        "last_updated": "2020-09-28",
        "certification_date": "2020-09-28",
        "status": "A",
        "authorized_official_last_name": "HERRING",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "REVENUE CYCLE DIRECTOR",
        "authorized_official_telephone_number": "334-240-2337"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Family Medicine Dalraida",
            "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 Sep 28, 2020; 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.