NPIMap

Jackson Hospital and Clinic, Inc

Organization Active NPI Endocrinology, Diabetes & Metabolism Physician · Montgomery, AL

NPI 1992377873 · NPPES record last updated Mar 9, 2026

Key facts

NPI
1992377873
Entity type
Organization (NPI type 2)
Primary specialty
Endocrinology, Diabetes & Metabolism Physician 207RE0101X
Legal business name
JACKSON HOSPITAL AND CLINIC, INC
Practice address
1801 Pine St Ste 204
Montgomery, AL 36106-1154
Phone
(334) 293-8877
Fax
(334) 293-6803
NPI assigned
Jul 12, 2021
Organization subpart
No

Authorized official

Name
Kelin Penney
Title
Executive Director
Phone
(334) 240-2335

Corporate family (same tax ID) 12

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in AL

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
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 (71 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207RE0101X Yes

Addresses

Primary practice location

1801 Pine St Ste 204
Montgomery, AL 36106-1154

Mailing address

1722 Pine St Ste 804
Montgomery, AL 36106-1108
Phone (334) 293-8736

Other names

  • Jackson Clinic Endocrinology Suite 204 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 9, 2026.

{
    "created_epoch": "1626048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773014400000",
    "number": "1992377873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1722 PINE ST STE 804",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361061108",
            "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": "1801 PINE ST STE 204",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361061154",
            "telephone_number": "334-293-8877",
            "fax_number": "334-293-6803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON HOSPITAL AND CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-12",
        "last_updated": "2026-03-09",
        "certification_date": "2026-03-09",
        "status": "A",
        "authorized_official_last_name": "PENNEY",
        "authorized_official_first_name": "KELIN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "334-240-2335"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Clinic Endocrinology Suite 204",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Montgomery, AL

All providers in Montgomery, AL · Endocrinology, Diabetes & Metabolism Physician in Alabama

Sources for this page

Verify at the official NPI Registry.