Healthcare Provider Details

I. General information

NPI: 1528095734
Provider Name (Legal Business Name): JEFFERSON HOSPITAL ASSOCIATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 DOCTORS DR
PINE BLUFF AR
71603-7015
US

IV. Provider business mailing address

1600 W 40TH AVE
PINE BLUFF AR
71603-6301
US

V. Phone/Fax

Practice location:
  • Phone: 870-541-7210
  • Fax: 870-541-7238
Mailing address:
  • Phone: 870-541-7210
  • Fax: 870-541-7238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateAR

VIII. Authorized Official

Name: MR. ROBERT ATKINSON
Title or Position: CEO
Credential:
Phone: 870-541-7269