Healthcare Provider Details

I. General information

NPI: 1851421861
Provider Name (Legal Business Name): JEFFERSON REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 870-541-7100
  • Fax: 870-541-7499
Mailing address:
  • Phone: 870-541-7100
  • Fax: 870-541-7499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR05666
License Number StateAR

VIII. Authorized Official

Name: MR. BRIAN THOMAS
Title or Position: PRESIDENT & CEO
Credential:
Phone: 870-541-7214