=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275306078
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IHP HOSPITAL MEDICINE - JACKSON PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2023
-----------------------------------------------------
Last Update Date | 05/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 N EAST AVE
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49201-1753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-536-2127
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 675469
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48267-5469
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-536-2127
-----------------------------------------------------
Fax | 248-893-6952
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. DAVID GERALD HALL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 248-536-2127
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------