ER PHYSICIAN GROUP AT JACKSON HOSPITAL (NPI# 1407801194) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407801194 |
| Entity Type | Organization |
| Organization Name | ER PHYSICIAN GROUP AT JACKSON HOSPITAL |
| Practice Address |
4250 Hospital Dr Marianna FL 32446-1917 |
| Practice Telephone | 8505262200 |
| Practice Fax Number | 8507182649 |
| Mailing Telephone | 8505262200 |
| Mailing Fax Number | 8507182649 |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2008-09-23 |
| Authorized Official Name | MR. KEVIN ROVITO (CFO) |
| Authorized Official Telephone | 8507182623 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities | ||
| N | 174400000X | Specialist | Other Service Providers | ||
| Y | 282NR1301X |
General Acute Care Hospital Specialization: Rural |
3999 | FL | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BLUE CROSS | 38679 | 01 |
| FL | 054877400 | 05 | |
| FL | MEDICARE RAIL ROAD | CJ6133 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790732881 | Er Physician Group At Jackson Hospital | Specialist | 4298 5th Ave, Marianna, FL 32446-2173 | 2006-05-27 |
| 1407895584 | Er Physician Group At Jackson Hospital | Specialist | 4298 5th Ave, Marianna, FL 32446-2173 | 2006-06-05 |
| Street Address |
4250 HOSPITAL DR |
| City | MARIANNA |
| State | FL |
| Zip Code | 32446-1917 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093700320 | Glenn L. Clark | Radiology | 4250 Hospital Dr, Marianna, FL 32446-1917 | 2005-09-13 |
| 1013481225 | Small Hospital Innovations LLC | Emergency Medicine | 4250 Hospital Dr, Marianna, FL 32446-1917 | 2019-01-22 |
| 1306341623 | Heath Rogers | Nurse Anesthetist, Certified Registered | 4250 Hospital Dr, Marianna, FL 32446-1917 | 2018-03-28 |
| 1679011001 | Andrea Davis | Nurse Anesthetist, Certified Registered | 4250 Hospital Dr, Marianna, FL 32446-1917 | 2017-02-06 |
| 1790146140 | Marianna Imaging, LLC | Specialist | 4250 Hospital Dr, Marianna, FL 32446-1917 | 2016-03-13 |
| 1992178727 | Summer Breeze Emergency Physicians, LLC | Physician Assistant | 4250 Hospital Dr, Marianna, FL 32446-1917 | 2015-11-02 |
| 1093187957 | Eminence Emergency Physicians, LLC | Physician Assistant | 4250 Hospital Dr, Marianna, FL 32446-1917 | 2015-10-30 |
| 1629460233 | Heather Stone | Nurse Anesthetist, Certified Registered | 4250 Hospital Dr, Marianna, FL 32446-1917 | 2015-02-19 |
| 1346652922 | Kayla L Gore | Registered Nurse | 4250 Hospital Dr, Marianna, FL 32446-1917 | 2014-05-29 |
| 1578989844 | Turtle Run Emergency Physicians | Emergency Medicine | 4250 Hospital Dr, Marianna, FL 32446-1917 | 2014-03-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962054817 | Covenant Home Health Care, LLC | Home Health | 4540 Lafayette Street, Ste. G, Marianna, FL 32446 | 2019-07-11 |
| 1063902930 | Syntha Alvarez | Assistant Behavior Analyst | 3217 Highway 71, Marianna, FL 32446 | 2018-05-15 |
| 1922528926 | Charlotte Allen | Respite Care | 4326 Deering Street, Marianna, FL 32446 | 2017-06-21 |
| 1003352097 | Jonathan Lee | Physical Therapist | 4387 Kelson Ave Apt A, Marianna, FL 32446 | 2017-01-13 |
| 1386003192 | Harold B Parker | Nurse Practitioner | Sunland Center 3700 Williams Drive, Marianna, FL 32446 | 2016-02-22 |
| 1912372756 | John Tyler Ellerbee | Nurse Practitioner | 4215 E Kelson Ave, Marianna, FL 32446 | 2015-12-04 |
| 1902206790 | Jason Williams | Spec/Tech, Cardiovascular | 3625 Fci Road, Marianna, FL 32446 | 2014-08-28 |
| 1336558238 | Rocky Mountain Holdings, LLC | Ambulance | 3689 Industrial Park Dr, Marianna, FL 32446 | 2014-08-05 |
| 1831430826 | Jantzen Wayne Whitehead | Counselor | 2860 Highway 71 N, Suite A, Marianna, FL 32446 | 2013-03-15 |
| 1336498047 | Sharon Lynn Miller | Counselor | 2933 Madison Street, Marianna, FL 32446 | 2012-09-10 |
| Find all providers in zip 32446 | ||||
| Taxonomy Code | 282NR1301X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| Specialization | Rural |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518395342 | Jackson County Hosptial District | General Acute Care Hospital | 4250 Hospital Dr, Marianna, FL 32446-1917 | 2013-10-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235660960 | Abegail Unico | General Acute Care Hospital | 116 Cypress Ln, Royal Palm Beach, FL 33411-8630 | 2017-03-24 |
| 1699210625 | Lakesha Ruise | General Acute Care Hospital | 638 Islamorada Dr N, Macclenny, FL 32063-8828 | 2016-12-29 |
| 1235683368 | Clinix Billing, LLC | General Acute Care Hospital | 12559 Foynes Ave, Windermere, FL 34786-6668 | 2016-08-05 |
| 1972985489 | Christine Truschka Larsen | General Acute Care Hospital | 1835 Sw 34th Ct, Ocala, FL 34474-2836 | 2015-06-19 |
| 1215353933 | Broward Health | General Acute Care Hospital | 1608 Se 3rd Avenue, Fort Lauderdale, FL 33316 | 2014-03-06 |
| 1174825624 | Tuba City Regional Health Care Center | General Acute Care Hospital | 1660 Foothill Ter, Deltona, FL 32725-6038 | 2010-12-03 |
| 1467534917 | H C Healthcare Inc | General Acute Care Hospital | 506 Nw 4th Street, Jasper, FL 32052-6603 | 2006-10-20 |
| 1801885413 | District Hospital Holdings Inc | General Acute Care Hospital | 39200 Hooker Hwy, Belle Glade, FL 33430 | 2005-10-17 |
| 1710984299 | Healthmark of Walton Inc | General Acute Care Hospital | 4413 Us Highway 331 S, Defuniak Springs, FL 32435-6307 | 2005-06-30 |
| 1295274983 | Miami Va Healthcare System | General Acute Care Hospital | 1201 Nw 16th St, Miami, FL 33125-1624 | 2017-02-15 |
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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.