# JACKSON HOSPITAL AND CLINIC, INC.

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

## Provider details

- **NPI number:** 1538455613
- **Authorized official:** KELIN PENNEY (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (334) 240-2335

## Contact information

- **Practice address:** 1725 PARK PL, SUITE 300-A, MONTGOMERY, AL 36106-1123
- **Practice address phone:** (334) 293-8000
- **Mailing address:** 1722 PINE ST STE 804, MONTGOMERY, AL 36106-1108
- **Mailing address phone:** (334) 270-9914
- **Mailing address fax:** (334) 270-3195

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | NULL | — |

## Other

- **Enumeration date:** 06/27/2011
- **Last updated:** 10/08/2026