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NPI Code Detail

MEDICARE: ER PHYSICIAN GROUP AT JACKSON HOSPITAL

MEDICARE: ER PHYSICIAN GROUP AT JACKSON HOSPITAL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist
2261QR1300XRural Health Clinic/Center
3282NR1301XRural Acute Care Hospital3999FL
4208D00000XGeneral Practice Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3CJ6133OTHERFLMEDICARE RAIL ROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
238679OTHERFLBLUE CROSS

General Provider Information

NPI Number : 1407801194
Entity Type Code : Organization
Provider Name (Legal Business Name) : ER PHYSICIAN GROUP AT JACKSON HOSPITAL
Provider Business Mailing Address
First Line : 4250 HOSPITAL DR
Second Line :
City : MARIANNA
State : FL
Zip : 32446-1917
Country : US
Telephone Number : 850-526-2200
Fax Number : 850-718-2649
Provider Business Practice Location Address
First Line : 4250 HOSPITAL DR
Second Line :
City : MARIANNA
State : FL
Zip : 32446-1917
Country : US
Telephone Number : 850-526-2200
Fax Number : 850-718-2649
Authorized Official
Title or Position : BILLING LIAISON
Name : MARGARET CARTER
Credential :
Telephone Number : 850-718-2531
Provider Enumeration Date : 05/23/2006
Last Update Date : 05/21/2026

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Directions to “ER PHYSICIAN GROUP AT JACKSON HOSPITAL ” Practice Location

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