# JACKSON HOSPITAL AND CLINIC, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jackson Clinic Colorectal Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306447958
- **Authorized official:** TARA HERRING (REVENUE CYCLE DIRECTOR)
- **Authorized official phone:** (334) 293-8736

## Contact information

- **Practice address:** 1722 PINE ST STE 402, MONTGOMERY, AL 36106-1159
- **Practice address phone:** (334) 293-8736
- **Practice address fax:** (334) 293-8738
- **Mailing address:** 1722 PINE ST STE 203, MONTGOMERY, AL 36106-1158
- **Mailing address phone:** (334) 293-8736
- **Mailing address fax:** (334) 293-8738

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208C00000X | Colon & Rectal Surgery Physician | — | NULL | Yes |
| 208C00000X | Colon & Rectal Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/02/2020
- **Last updated:** 11/02/2020