Healthcare Provider Details

I. General information

NPI: 1275306078
Provider Name (Legal Business Name): IHP HOSPITAL MEDICINE - JACKSON PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N EAST AVE
JACKSON MI
49201-1753
US

IV. Provider business mailing address

PO BOX 675469
DETROIT MI
48267-5469
US

V. Phone/Fax

Practice location:
  • Phone: 248-536-2127
  • Fax:
Mailing address:
  • Phone: 248-536-2127
  • Fax: 248-893-6952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID GERALD HALL
Title or Position: CEO
Credential: MD
Phone: 248-536-2127