JACKSON HOSPITAL AND CLINIC INC. (NPI# 1164878856) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164878856 |
| Entity Type | Organization |
| Organization Name | JACKSON HOSPITAL AND CLINIC INC. |
| Other Organization Name | JACKSON CLINIC CARDIOLOGY |
| Practice Address |
461 E Main St Prattville AL 36067-3409 |
| Mailing Address |
1722 Pine St Suite 503 Montgomery AL 36106-1103 |
| Practice Telephone | 3342649191 |
| Practice Fax Number | 3342649199 |
| Mailing Telephone | 3342402337 |
| Mailing Fax Number | 3342936859 |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2016-05-11 |
| Authorized Official Name | KELIN PENNEY (ADMINISTRATOR) |
| Authorized Official Telephone | 3342402335 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Jackson Clinic Cardiology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194256438 | Jackson Hospital and Clinic Inc. | Surgery | 1722 Pine St Ste 201, Montgomery, AL 36106-1158 | 2017-03-27 |
| 1053844654 | Jackson Hospital and Clinic Inc. | Urology | 515 Hospital Dr, Suite A, Wetumpka, AL 36092-1626 | 2017-04-10 |
| 1578003745 | Jackson Hospital and Clinic Inc. | Internal Medicine | 1758 Park Pl, Suite 406, Montgomery, AL 36106-1127 | 2017-03-07 |
| 1841736683 | Jackson Hospital and Clinic Inc. | Internal Medicine | 1722 Pine St, Suite 204, Montgomery, AL 36106-1103 | 2017-01-18 |
| 1194261669 | Jackson Hospital and Clinic Inc. | Internal Medicine | 1758 Park Pl, Suite 402, Montgomery, AL 36106-1127 | 2017-01-09 |
| 1376097089 | Jackson Hospital and Clinic Inc. | Internal Medicine | 1722 Pine St, Suite 406, Montgomery, AL 36106-1103 | 2016-08-10 |
| 1588011746 | Jackson Hospital and Clinic Inc. | Surgery | 1801 Pine St, Suite 101, Montgomery, AL 36106-0165 | 2016-05-18 |
| 1811350390 | Jackson Hospital and Clinic Inc. | Internal Medicine | 124 S Memorial Dr, Prattville, AL 36067-3619 | 2016-04-01 |
| 1528449386 | Jackson Hospital and Clinic Inc. | Durable Medical Equipment & Medical Supplies | 1722 Pine St, Suite 502, Montgomery, AL 36106-1103 | 2015-06-17 |
| 1023317666 | Jackson Hospital and Clinic Inc. | Family Medicine | 1801 Pine Street, Suite 103, Montgomery, AL 36106-1160 | 2011-03-22 |
| Street Address |
461 E MAIN ST |
| City | PRATTVILLE |
| State | AL |
| Zip Code | 36067-3409 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427044395 | Charles Garrison Cloutier | Family Medicine | 461 E Main St, Prattville, AL 36067-3409 | 2005-09-26 |
| 1588211841 | We Care Family Medicine, LLC | Family Medicine | 461 E Main St, Prattville, AL 36067-3409 | 2019-08-21 |
| 1689858797 | Alabama Orthopaedic Specialists, P.a. | Orthopaedic Surgery | 461 E Main St, Prattville, AL 36067-3409 | 2007-12-26 |
| 1558545160 | Jennifer Maguire Groff | Nurse Practitioner | 461 E Main St, Prattville, AL 36067-3409 | 2007-12-19 |
| 1568641454 | Charles G. Cloutier, M.d., P.C. | Family Medicine | 461 E Main St, Prattville, AL 36067-3409 | 2007-10-29 |
| 1801879416 | Kevin A Coady Family Practice Inc | Family Medicine | 461 E Main St, Prattville, AL 36067-3409 | 2005-11-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316352552 | Agape Me LLC | Case Manager/Care Coordinator | 353 Bent Tree Dr., Prattville, AL 36067 | 2014-06-26 |
| 1770868671 | Susan Elizabeth Swink | Pharmacist | 703 South Memorial Dr, Walgreens Pharmacy, Prattville, AL 36067 | 2011-10-12 |
| 1255501458 | Edwin R. Mullins | Dentist | 268 1st St., Prattville, AL 36067 | 2008-03-04 |
| 1598891046 | James Ronald Roberson Sr. | Dentist | 113 E Main, Prattville, AL 36067 | 2007-02-26 |
| 1326184029 | Prattville Primary Care LLC | Family Medicine | 461 E Main Street, Prattville, AL 36067 | 2007-01-29 |
| 1669591418 | Walter Eugene Parker | Family Medicine | 107 Quail Run, Prattville, AL 36067 | 2007-03-29 |
| 1376582049 | James Daniel Cartwright | Internal Medicine | 808 Durden Rd, Prattville, AL 36067-1533 | 2006-06-06 |
| 1386162816 | Logan Elizabeth Dodd | Speech-Language Pathologist | 815 Durden Rd, Prattville, AL 36067-1534 | 2017-09-05 |
| 1891182200 | Steve Weedon | Specialist/Technologist | 1218 Kingston Garden Rd, Prattville, AL 36067-1704 | 2015-04-23 |
| 1780042887 | James K Nichols Jr. | Nurse Anesthetist, Certified Registered | 101 Coleman Dr, Prattville, AL 36067-1766 | 2016-02-03 |
| Find all providers in zip 36067 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750742318 | Jackson Hospital and Clinic Inc | Internal Medicine | 707 Mcqueen Smith Rd S, Prattville, AL 36066-7503 | 2016-03-10 |
| 1811350390 | Jackson Hospital and Clinic Inc. | Internal Medicine | 124 S Memorial Dr, Prattville, AL 36067-3619 | 2016-04-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124674098 | Jamie Torres | Internal Medicine | 1118 Ross Clark Cir Ste 403, Dothan, AL 36301-3038 | 2019-08-15 |
| 1770040255 | Druid City Vascular, P.C. | Internal Medicine | 701 University Blvd E Ste 608, Tuscaloosa, AL 35401-7411 | 2019-02-21 |
| 1962933796 | Robert Derenbecker | Internal Medicine | 1808 7th Avenue South Bdb 201, Birmingham, AL 35294-0010 | 2017-03-23 |
| 1770944340 | Jackson Hospital and Clinic, Inc | Internal Medicine | 74238 Tallassee Hwy, Wetumpka, AL 36092-5504 | 2016-03-10 |
| 1053791764 | Multi-specialty Care-cardiac Care In South, LLC | Internal Medicine | 4490 Al Highway 22, Valley Grande, AL 36701-0501 | 2015-06-08 |
| 1922497312 | Michael Mckinney Cardiology PC | Internal Medicine | 1110 Lakeview Cres, Birmingham, AL 35205-1119 | 2015-01-22 |
| 1194160580 | David Huntsman Jackson | Internal Medicine | 3647 Dunbarton Dr, Mountain Brk, AL 35223-2891 | 2013-04-30 |
| 1700136728 | Farnoosh Rahimi | Internal Medicine | 2451 Fillingim St Bldg C, Mobile, AL 36617 | 2012-09-17 |
| 1720333867 | Rayan Saab | Internal Medicine | 801 Princeton Ave Sw Ste 707, Birmingham, AL 35211-1395 | 2012-07-15 |
| 1003187642 | Anand Shanker Balachandran | Internal Medicine | 333 Whitesport Dr Sw Ste 304, Huntsville, AL 35801-3455 | 2012-01-12 |
| Find all providers with the same taxonomy | ||||
| City | PRATTVILLE |
| Zip Code | 36067 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.