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General NPI Number Information
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NPI Number | 1710265905
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Entity Type | Organization
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Legal Business Name | JACKSON HOSPITAL AND CLINIC, INC.
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Dates
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Enumeration Date | 07/22/2011
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 1801 PINE ST SUITE 203
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City | MONTGOMERY
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State | AL
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Zip | 36106-0165
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Country | US
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Telephone | 334-293-8877
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Fax | 334-293-6803
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Provider Business Mailing Address
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Address Line | 1722 PINE ST SUITE 503
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City | MONTGOMERY
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State | AL
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Zip | 36106-1103
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Country | US
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Telephone | 334-270-9914
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Fax | 334-270-3195
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Authorized Official
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Title or Position | CFO
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Name | MR. PETER VERRECCHIA
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Credential |
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Telephone | 334-293-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | MD.30788
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License Number State | AL
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