Provider Demographics
NPI:1356917892
Name:ER PHYSICIAN GROUP AT JACKSON HOSPITAL
Entity type:Organization
Organization Name:ER PHYSICIAN GROUP AT JACKSON HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PAYER CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-718-2531
Mailing Address - Street 1:4250 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-1917
Mailing Address - Country:US
Mailing Address - Phone:850-526-6727
Mailing Address - Fax:850-526-1027
Practice Address - Street 1:1798 GEORGIA ST
Practice Address - Street 2:
Practice Address - City:ALFORD
Practice Address - State:FL
Practice Address - Zip Code:32420-6800
Practice Address - Country:US
Practice Address - Phone:850-526-6727
Practice Address - Fax:850-526-1027
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ER PHYSICIAN GROUP AT JACKSON HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-03
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty