Provider Demographics
NPI:1154669752
Name:JACKSON HOSPITAL AND CLINIC INC
Entity Type:Organization
Organization Name:JACKSON HOSPITAL AND CLINIC INC
Other - Org Name:JACKSON HOSPITAL AND CLINIC INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RITZUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-293-8000
Mailing Address - Street 1:1722 PINE ST
Mailing Address - Street 2:STE 503
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1722 PINE ST
Practice Address - Street 2:STE 503
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1103
Practice Address - Country:US
Practice Address - Phone:334-239-8000
Practice Address - Fax:334-239-8000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty