Healthcare Provider Details

I. General information

NPI: 1497102040
Provider Name (Legal Business Name): JEFFERSON HOSPITAL ASSOCIATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W 40TH AVE STE 6A
PINE BLUFF AR
71603-6963
US

IV. Provider business mailing address

PO BOX 2650
PINE BLUFF AR
71613-2650
US

V. Phone/Fax

Practice location:
  • Phone: 870-541-9373
  • Fax: 870-541-0109
Mailing address:
  • Phone: 870-541-7235
  • Fax: 870-541-4297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN THOMAS
Title or Position: SR. VP AND COO
Credential:
Phone: 870-541-7235