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JACKSON HOSPITAL AND CLINIC INC.
NPI 1194261669
Internal Medicine - Cardiovascular Disease in Montgomery, AL

Active since January 09, 2017CLIA 01D2130568 · Waiver
1758 PARK PL, SUITE 402, MONTGOMERY, AL 36106(334) 293-6842(334) 293-6843 Get Directions Write a Review

NPPES record last updated: March 9, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 9, 2026, Jan 9, 2017 (2 updates tracked since 2017).

About Jackson Hospital And Clinic Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACKSON HOSPITAL AND CLINIC INC. (NPI 1194261669), doing business as Jackson Clinic Cardiology Suite 402, is a healthcare organization registered as a cardiovascular disease in Montgomery, Alabama and active in the NPI registry since January 2017. The organization holds a CLIA Waiver certificate valid through May 10, 2027 and lists Kelin Penney, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1194261669
Entity TypeOrganization
Primary Taxonomy207RC0000X
Legal Business NameJACKSON HOSPITAL AND CLINIC INC.
Location Address1758 PARK PL, SUITE 402Montgomery, AL 36106-1127
Mailing Address1722 Pine St Ste 804Montgomery, AL 36106-1108 · (334) 240-2337 · Fax (334) 293-8738
Phone(334) 293-6842
Fax(334) 293-6843
Organization SubpartNo
Authorized OfficialKelin PenneyExecutive Director · (334) 240-2335
Enumeration DateJanuary 9, 2017
Last NPPES UpdateMarch 9, 20262 updates tracked since enumeration
NPPES CertifiedMarch 9, 2026
✔ NPI 1194261669 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Cardiovascular DiseaseAllopathic & Osteopathic Physicians
Taxonomy Code207RC0000X
Definition
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.
1758 PARK PL, Montgomery, AL 36106
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Other Names 1

Doing Business AsJackson Clinic Cardiology Suite 402

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 01D2130568

Jackson Hospital & Clinic Inc · Montgomery, AL
Active · expires May 10, 2027
CLIA Number01D2130568
Laboratory TypePhysician Office
Certificate Effective DateMay 11, 2025
Certificate Expiration DateMay 10, 2027
Laboratory DirectorBeverly Stoudemire-Howlett
Laboratory Phone(334) 293-6842
Laboratory LocationJackson Hospital & Clinic Inc1758 Park Place Suite 402, Montgomery, AL 36106
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 19

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SOUTHEAST CANCER NETWORK, INC
Internal Medicine (Hematology & Oncology)
1758 PARK PL, SUITE 301
MONTGOMERY, AL 36106
Montgomery County (205) 366-9740
STEWART H TANKERSLEY, MD, LLC
Clinic/Center
1758 PARK PL, SUITE 200
MONTGOMERY, AL 36106
Montgomery County (334) 538-9695
MR. WES HOLLAND C.PED.
Orthotist
1758 PARK PL, SUITE 300
MONTGOMERY, AL 36106
Montgomery County (334) 538-7696
CAPITAL CARDIOTHORACIC, PC
Thoracic Surgery (Cardiothoracic Vascular Surgery)
1758 PARK PL, SUITE 202
MONTGOMERY, AL 36106
Montgomery County (334) 264-7156
DR. DAVID LAWRENCE KOURI M.D.
Legal Medicine
1758 PARK PL, SUITE 201
MONTGOMERY, AL 36106
Montgomery County (334) 263-3630
LATOYA SHANTEL CLARK MD
Obstetrics & Gynecology
1758 PARK PL, SUITE 406
MONTGOMERY, AL 36106
Montgomery County (251) 716-4744
JACKSON HOSPITAL AND CLINIC INC
Thoracic Surgery (Cardiothoracic Vascular Surgery)
1758 PARK PL, SUITE 202
MONTGOMERY, AL 36106
Montgomery County (334) 264-7156
JOHN A PORTER MD PC
Obstetrics & Gynecology (Gynecology)
1758 PARK PL, SUITE 406
MONTGOMERY, AL 36106
Montgomery County (334) 284-1500

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jackson Hospital And Clinic Inc.'s NPI number?

The NPI number for Jackson Hospital And Clinic Inc. is 1194261669. It was assigned to this organization in the NPPES registry on January 9, 2017. The provider is doing business as Jackson Clinic Cardiology Suite 402.

Where is Jackson Hospital And Clinic Inc. located?

Jackson Hospital And Clinic Inc. is located at 1758 Park Pl Suite 402, Montgomery, AL 36106. The listed phone number is (334) 293-6842.

What is Jackson Hospital And Clinic Inc.'s specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Cardiovascular Disease, with taxonomy code 207RC0000X.

Does Jackson Hospital And Clinic Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 01D2130568) is associated with this NPI, valid through May 10, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Jackson Hospital And Clinic Inc. was last updated on March 9, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.