JACKSON HOSPITAL AND CLINIC, INC. (NPI# 1760770754) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760770754 |
| Entity Type | Organization |
| Organization Name | JACKSON HOSPITAL AND CLINIC, INC. |
| Other Organization Name | JACKSON CLINIC UROLOGY |
| Practice Address |
1722 Pine St Suite 502 Montgomery AL 36106-1103 |
| Mailing Address |
1722 Pine St Ste 503 Montgomery AL 36106-1103 |
| Practice Telephone | 3342938588 |
| Mailing Telephone | 3342709914 |
| Mailing Fax Number | 3342703195 |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2018-06-16 |
| Authorized Official Name | MRS. TARA HERRING (REVENUE CYCLE DIRECTOR) |
| Authorized Official Telephone | 3342402337 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | MD.31014 | AL | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Jackson Clinic Urology | 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 |
| 1205494416 | Jackson Hospital and Clinic, Inc. | Urology | 1722 Pine St Ste 503, Montgomery, AL 36106-1160 | 2019-06-03 |
| 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 |
| Street Address |
1722 PINE ST SUITE 502 |
| City | MONTGOMERY |
| State | AL |
| Zip Code | 36106-1103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316949472 | Aubrey Ayers Stabler Jr. | Otolaryngology | 1722 Pine St, Suite 804, Montgomery, AL 36106-1108 | 2005-06-02 |
| 1609435155 | Virginia Mcdaniel | Nurse Practitioner | 1722 Pine St, Montgomery, AL 36106-1103 | 2019-06-09 |
| 1841736683 | Jackson Hospital and Clinic Inc. | Internal Medicine | 1722 Pine St, Suite 204, Montgomery, AL 36106-1103 | 2017-01-18 |
| 1376097089 | Jackson Hospital and Clinic Inc. | Internal Medicine | 1722 Pine St, Suite 406, Montgomery, AL 36106-1103 | 2016-08-10 |
| 1407300304 | Jackson Hospital and Clinic Inc | Surgery | 1722 Pine St, Suite 904, Montgomery, AL 36106-1103 | 2016-08-09 |
| 1619352895 | Tammie Holcey | Nurse Practitioner | 1722 Pine St, Suite 1005, Montgomery, AL 36106-1103 | 2015-07-29 |
| 1528449386 | Jackson Hospital and Clinic Inc. | Durable Medical Equipment & Medical Supplies | 1722 Pine St, Suite 502, Montgomery, AL 36106-1103 | 2015-06-17 |
| 1285030080 | Greater Montgomery Patient Centered Gastroenterology and Hepatology | Internal Medicine | 1722 Pine St, Suite 801, Montgomery, AL 36106-1103 | 2014-11-06 |
| 1396152823 | S Louis Armstrong Md PC | Surgery | 1722 Pine St, Suite 201, Montgomery, AL 36106-1103 | 2014-07-16 |
| 1154669752 | Jackson Hospital and Clinic Inc | Surgery | 1722 Pine St, Ste 503, Montgomery, AL 36106-1103 | 2013-01-17 |
| Find all providers in the same location | ||||
| 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 | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942540190 | Andrew Charles Von Eschenbach | Urology | 163 Sarasota Cir S, Montgomery, TX 77356-8406 | 2013-02-26 |
| 1497764104 | Tony E Pinson | Urology | 470 Taylor Rd Ste 201, Montgomery, AL 36117-3532 | 2006-08-05 |
| 1831189158 | William Todd Sherrer | Urology | 226 Mitylene Park Dr, Montgomery, AL 36117-3548 | 2005-10-27 |
| 1164803367 | Jackson Hospital and Clinic Inc | Urology | 226 Mitylene Park Dr, Montgomery, AL 36117-3548 | 2015-06-12 |
| 1255764007 | Wetumpka Urology LLC | Urology | 2257 Taylor Rd, Suite 200, Montgomery, AL 36117-7790 | 2013-08-15 |
| 1013287648 | The Health Care Authority for Baptist Health, An Affiliate of Uabhs | Urology | 470 Taylor Rd, Suite 202, Montgomery, AL 36117-3563 | 2012-01-12 |
| 1730323056 | Joshua Crocker Waits | Urology | 1722 Pine St, Suite 502, Montgomery, AL 36106-1103 | 2009-04-30 |
| 1962667873 | Gloria Susan Massey | Urology | 2055 E South Blvd, Suite 802, Montgomery, AL 36116-2001 | 2008-07-21 |
| 1316106164 | Himanshu Aggarwal | Urology | 1722 Pine St Ste 503, Montgomery, AL 36106 | 2008-06-06 |
| 1083882096 | Geoffrey Michael Habermacher | Urology | 2119 E South Blvd, Suite 200, Montgomery, AL 36116-2454 | 2008-02-12 |
| Find all providers in MONTGOMERY | ||||
| 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.