Organization
CHIPOLA SURGICAL AND MEDICAL SPECIALTIES
Active
Parent organization
ER PHYSICIANS GROUP AT JACKSON HOSPITAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
ER PHYSICIANS GROUP AT JACKSON HOSPITAL
Authorized official
DR. MURALI KRISHNA MADDIPATI MD (MD)
(513) 254-2645
Entity
Organization
Contact information
Practice address
2946 JEFFERSON ST, MARIANNA, FL 32446-3140
(850) 526-3314
Mailing address
2946 JEFFERSON ST, MARIANNA, FL 32446-3140
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
ME106347
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
054877400
—
FL
Enumeration date
03/27/2013
Last updated
03/27/2013
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