Provider Demographics
NPI:1366808404
Name:CITY OF JACKSON HEALTHCARE AUTHORITY
Entity type:Organization
Organization Name:CITY OF JACKSON HEALTHCARE AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-246-4446
Mailing Address - Street 1:220 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:AL
Mailing Address - Zip Code:36545-2459
Mailing Address - Country:US
Mailing Address - Phone:251-246-9021
Mailing Address - Fax:
Practice Address - Street 1:227 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:AL
Practice Address - Zip Code:36545-2423
Practice Address - Country:US
Practice Address - Phone:251-246-4446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACKSON MEDICAL CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-05
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty