JACKSON HOSPITAL AND CLINIC INC (NPI# 1750742318) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750742318 |
| Entity Type | Organization |
| Organization Name | JACKSON HOSPITAL AND CLINIC INC |
| Other Organization Name | JACKSON CLINIC CARDIOLOGY |
| Practice Address |
707 Mcqueen Smith Rd S Prattville AL 36066-7503 |
| Mailing Address |
1722 Pine St Suite 503 Montgomery AL 36106-1103 |
| Practice Telephone | 3342649191 |
| Practice Fax Number | 3342649199 |
| Mailing Telephone | (334) 240-2337 |
| Mailing Fax Number | 3342936859 |
| Enumeration Date | 2016-03-10 |
| Last Update Date | 2018-06-16 |
| 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 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 645 Mcqueen Smith Rd N, Suite 108, Prattville, AL 360667268 | 3342649191 | 3342649199 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407387848 | Jackson Hospital and Clinic Inc | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1758 Park Pl, Suite 202, Montgomery, AL 36106-1127 | 2017-03-27 |
| 1407300304 | Jackson Hospital and Clinic Inc | Surgery | 1722 Pine St, Suite 904, Montgomery, AL 36106-1103 | 2016-08-09 |
| 1891156469 | Jackson Hospital and Clinic Inc | Internal Medicine | 115 Herren Hill Rd, Tallassee, AL 36078-1276 | 2016-03-10 |
| 1912362773 | Jackson Hospital and Clinic Inc | Internal Medicine | 1758 Park Pl, Suite 401, Montgomery, AL 36106-1127 | 2015-12-22 |
| 1679946610 | Jackson Hospital and Clinic Inc | Neurological Surgery | 1801 Pine St, Suite 202, Montgomery, AL 36106-0165 | 2015-11-12 |
| 1740657683 | Jackson Hospital and Clinic Inc | Surgery | 44 Medical Arts Ct, Greenville, AL 36037-3869 | 2015-08-26 |
| 1164803367 | Jackson Hospital and Clinic Inc | Urology | 226 Mitylene Park Dr, Montgomery, AL 36117-3548 | 2015-06-12 |
| 1558764266 | Jackson Hospital and Clinic Inc | Obstetrics & Gynecology | 1758 Park Pl, Suite 301, Montgomery, AL 36106-1127 | 2014-10-08 |
| 1831513787 | Jackson Hospital and Clinic Inc | Surgery | 7201 Copperfield Dr, Montgomery, AL 36117-7101 | 2014-02-13 |
| 1154669752 | Jackson Hospital and Clinic Inc | Surgery | 1722 Pine St, Ste 503, Montgomery, AL 36106-1103 | 2013-01-17 |
| Street Address |
707 MCQUEEN SMITH RD S |
| City | PRATTVILLE |
| State | AL |
| Zip Code | 36066-7503 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659879633 | Jackson Hospital and Clinic, Inc | Internal Medicine | 707 Mcqueen Smith Rd S, Prattville, AL 36066-7503 | 2018-01-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053856591 | Camellia Hospice of South Alabama, LLC | Hospice Care, Community Based | 1807 Station Dr Ste B, Prattville, AL 36066 | 2016-12-19 |
| 1265805550 | Alabama Dental Professionals, PC | Dentist | 2489 Cobbs Ford Road, Prattville, AL 36066 | 2015-11-09 |
| 1407243645 | Drayer Physical Therapy-alabama, LLC | Physical Therapist | 2703 Legends Parkway, Prattville, AL 36066 | 2015-04-24 |
| 1225396203 | Kristin Taylor | Occupational Therapist | 635 Mcqueen Smith Road, Suite D, Prattville, AL 36066 | 2012-04-27 |
| 1164796959 | Glynwood Park Dental Care | Dentist | 1831 Glynwood Drive, Prattville, AL 36066 | 2012-02-27 |
| 1790068757 | Jason Duane Weaver | Physical Therapist | 1824 Glynwood Drive, Prattville, AL 36066 | 2011-09-26 |
| 1982931499 | Health Star Inc | Chiropractor | 2441 Cobbs Ford Road, Prattville, AL 36066 | 2009-11-05 |
| 1023101698 | Drs. Tatum and Walker, L.L.C. | Dentist | 597 South Memorial Drive, Prattville, AL 36066 | 2006-10-02 |
| 1730290693 | Shalini Goswami | Internal Medicine | 1294 E Main St, Prattville, AL 36066 | 2006-08-31 |
| 1407860380 | Robert Allen Avery | Internal Medicine | 645 Mcqueen Smith Rd N Ste 207, Prattville, AL 36066 | 2006-07-28 |
| Find all providers in zip 36066 | ||||
| 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 |
|---|---|---|---|---|
| 1164878856 | Jackson Hospital and Clinic Inc. | Internal Medicine | 461 E Main St, Prattville, AL 36067-3409 | 2016-05-11 |
| 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 | 36066 |
Please comment or provide details below to improve the information on JACKSON HOSPITAL AND CLINIC INC.
| 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.