# JACKSON SURGERY CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336375930
- **Authorized official:** MISSY SALLAS (ADMINISTRATOR)
- **Authorized official phone:** (334) 293-3920

## Contact information

- **Practice address:** 1725 PARK PL, MONTGOMERY, AL 36106-1138
- **Practice address phone:** (334) 293-8484
- **Practice address fax:** (334) 293-6880
- **Mailing address:** 1725 PARK PL, MONTGOMERY, AL 36106-1138
- **Mailing address phone:** (334) 293-8484
- **Mailing address fax:** (334) 293-6880

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | PENDING | AL | Yes |

## Other

- **Enumeration date:** 06/09/2009
- **Last updated:** 02/14/2022