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Organization
JACKSON HOSPITAL AND CLINIC INC.
Active
Organization
JACKSON HOSPITAL AND CLINIC INC.
Active
Other names
Jackson Vascular Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
KELIN PENNEY (ADMINISTRATOR)
(334) 240-2335
Entity
Organization
Contact information
Practice address
1801 PINE ST, SUITE 101, MONTGOMERY, AL 36106-0165
(334) 293-8922
(334) 293-6820
Mailing address
1722 PINE ST, SUITE 503, MONTGOMERY, AL 36106-1103
(334) 293-8736
(334) 293-6859
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
NULL
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Enumeration date
05/18/2016
Last updated
05/18/2016
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