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General NPI Number Information
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NPI Number | 1023277746
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Entity Type | Organization
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Legal Business Name | JEFFERSON COMPREHENSIVE CARE SYSTEM INC
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Dates
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Enumeration Date | 06/06/2008
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Last Update Date | 06/06/2008
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Provider Practice Location Address
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Address Line | 1101 TENNESSEE ST
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City | PINE BLUFF
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State | AR
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Zip | 71601-5801
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Country | US
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Telephone | 870-543-2341
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Fax | 870-535-4716
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Provider Business Mailing Address
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Address Line | PO BOX 1285
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City | PINE BLUFF
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State | AR
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Zip | 71613-1285
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Country | US
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Telephone | 870-543-2341
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Fax | 870-535-4716
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. LARNELL W DAVIS
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Credential |
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Telephone | 870-543-2380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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