Healthcare Provider Details

I. General information

NPI: 1053484782
Provider Name (Legal Business Name): JEFFERSON HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 CLAUD RD
PINE BLUFF AR
71602-8622
US

IV. Provider business mailing address

1400 CLAUD RD
WHITE HALL AR
71602-8622
US

V. Phone/Fax

Practice location:
  • Phone: 870-247-9499
  • Fax:
Mailing address:
  • Phone: 870-247-9499
  • Fax: 870-247-5312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberE2876
License Number StateAR

VIII. Authorized Official

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