1982940433 NPI number — JEFFERSON HOSPITAL ASSN, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982940433 NPI number — JEFFERSON HOSPITAL ASSN, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFERSON HOSPITAL ASSN, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982940433
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2320
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINE BLUFF
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71613-2320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-541-5981
Provider Business Mailing Address Fax Number:
870-541-8730

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1609 W 40TH AVE
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
PINE BLUFF
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71603-6319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-541-0668
Provider Business Practice Location Address Fax Number:
870-541-0083
Provider Enumeration Date:
01/02/2013

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
870-541-7269

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , with the licence number:  C6122 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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