JACKSON HOSPITAL AND CLINIC, INC. (NPI# 1205494416) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205494416 |
| Entity Type | Organization |
| Organization Name | JACKSON HOSPITAL AND CLINIC, INC. |
| Practice Address |
1722 Pine St Ste 503 Montgomery AL 36106-1160 |
| Practice Telephone | 3342938736 |
| Practice Fax Number | 3342938738 |
| Mailing Telephone | 3342938736 |
| Mailing Fax Number | 3342938738 |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2019-06-03 |
| Authorized Official Name | TARA HERRING (REVENUE CYCLE DIRECTOR) |
| Authorized Official Telephone | 3342402337 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2088F0040X |
Urology Specialization: Female Pelvic Medicine and Reconstructive Surgery |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Jackson Clinic Urogynecology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477029072 | Jackson Hospital and Clinic, Inc. | Obstetrics & Gynecology | 1722 Pine St Ste 603, Montgomery, AL 36106-1114 | 2018-10-22 |
| 1497240998 | Jackson Hospital and Clinic, Inc. | Internal Medicine | 1722 Pine St Ste 801, Montgomery, AL 36106-1108 | 2018-06-27 |
| 1477171072 | Jackson Hospital and Clinic, Inc. | Family Medicine | 204 Medical Center Dr, Prattville, AL 36066-7288 | 2020-07-09 |
| 1730727744 | Jackson Hospital and Clinic, Inc. | Specialist | 1840 E Main St, Prattville, AL 36066-5500 | 2019-12-20 |
| 1952949968 | Jackson Hospital and Clinic, Inc. | Pediatrics | 4154 Carmichael Rd, Montgomery, AL 36106-2866 | 2019-12-20 |
| 1992296370 | Jackson Hospital and Clinic, Inc. | Surgery | 1722 Pine St Ste 503, Montgomery, AL 36106-1160 | 2018-05-22 |
| 1306229190 | Jackson Hospital and Clinic, Inc. | Hospitalist | 1725 Pine St, Montgomery, AL 36106-1109 | 2015-06-30 |
| 1720325889 | Jackson Hospital and Clinic, Inc. | Family Medicine | 701 Mcqueen Smith Rd S, Prattville, AL 36066-7503 | 2013-01-09 |
| 1710265905 | Jackson Hospital and Clinic, Inc. | Internal Medicine | 1801 Pine St, Suite 203, Montgomery, AL 36106-0165 | 2011-07-22 |
| 1760770754 | Jackson Hospital and Clinic, Inc. | Urology | 1722 Pine St, Suite 502, Montgomery, AL 36106-1103 | 2011-07-12 |
| Street Address |
1722 PINE ST STE 503 |
| City | MONTGOMERY |
| State | AL |
| Zip Code | 36106-1160 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780733220 | Randal M Sedlak | Surgery | 1722 Pine St Ste 503, Montgomery, AL 36106-1160 | 2007-01-10 |
| 1992296370 | Jackson Hospital and Clinic, Inc. | Surgery | 1722 Pine St Ste 503, Montgomery, AL 36106-1160 | 2018-05-22 |
| 1316106164 | Himanshu Aggarwal | Urology | 1722 Pine St Ste 503, Montgomery, AL 36106 | 2008-06-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235747205 | Rural Urgent Care LLC | Clinic/Center | 3039 Vaughn Road, Montgomery, AL 36106 | 2020-07-16 |
| 1548733306 | Bennett Family Dentistry, LLC | Dentist | 4270 Carmichael Road, Montgomery, AL 36106 | 2019-01-04 |
| 1588133854 | Lori Leanne Fail | Physical Therapist | 1615 Windsor Hill Court, Montgomery, AL 36106 | 2018-11-16 |
| 1073020749 | Charlene Richmond Harrell | Chiropractor | 2900 Zelda Rd., Suite A, Montgomery, AL 36106 | 2018-01-03 |
| 1780123109 | Montgomery Accident and Injury Center, Inc | Nurse Practitioner | 2900 Zelda Rd, Ste B, Montgomery, AL 36106 | 2017-02-17 |
| 1467843573 | Ernest Porterfield | Non-emergency Medical Transport (VAN) | 4183 Carmichael Road, Suite A, Montgomery, AL 36106 | 2015-02-11 |
| 1114334281 | Daniel Gerald O'bryant | Specialist/Technologist | 1160 Navarro Avenue, Montgomery, AL 36106 | 2014-07-21 |
| 1801213764 | Amanda Hodge | Specialist/Technologist | 4605 Cherry Tree Terrace, Montgomery, AL 36106 | 2014-03-27 |
| 1871861542 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1758 Park Pl Ste 102, Montgomery, AL 36106 | 2011-12-08 |
| 1578862546 | Helping Hands Preventitive Health Center | Community/Behavioral Health | 2015 Mulberry St, Montgomery, AL 36106 | 2011-03-16 |
| Find all providers in zip 36106 | ||||
| Taxonomy Code | 2088F0040X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| Specialization | Female Pelvic Medicine and Reconstructive Surgery |
| A subspecialist in Female Pelvic Medicine and Reconstructive Surgery is a physician in Urology or Obstetrics and Gynecology who, by virtue of education and training, is prepared to provide consultation and comprehensive management of women with complex benign pelvic conditions, lower urinary tract disorders, and pelvic floor dysfunction. Comprehensive management includes those diagnostic and therapeutic procedures necessary for the total care of the patient with these conditions and complications resulting from them. |
| Notes: Source: American Board of Medical Specialties, 2011. [1/1/2012: new] Resources: www.abms.org |
| City | MONTGOMERY |
| Zip Code | 36106 |
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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.