Provider Demographics
NPI:1164480893
Name:HOSPITALISTS OF JACKSON LLC
Entity Type:Organization
Organization Name:HOSPITALISTS OF JACKSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN/PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUNKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-805-1300
Mailing Address - Street 1:PO BOX 534255
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-4255
Mailing Address - Country:US
Mailing Address - Phone:800-514-1494
Mailing Address - Fax:904-805-1456
Practice Address - Street 1:367 HOSPITAL BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2080
Practice Address - Country:US
Practice Address - Phone:731-661-2185
Practice Address - Fax:731-661-2187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3727496Medicaid
TN3727496Medicaid
TN3727496Medicare PIN
TN=========OtherTRICARE GROUP #