Provider Demographics
NPI:1245750660
Name:JACKSON HOSPITAL & CLINIC, INC.
Entity Type:Organization
Organization Name:JACKSON HOSPITAL & CLINIC, INC.
Other - Org Name:JACKSON FAMILY MEDICINE MIDTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-240-2337
Mailing Address - Street 1:1722 PINE ST STE 503
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1160
Mailing Address - Country:US
Mailing Address - Phone:334-293-8736
Mailing Address - Fax:334-293-8738
Practice Address - Street 1:4150 CARMICHAEL RD STE B
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2933
Practice Address - Country:US
Practice Address - Phone:334-293-8282
Practice Address - Fax:334-293-8286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty