1306097365 NPI number — JEFFERSON HOSPITAL ASSOCIATION, INC.

Table of content: (NPI 1306097365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306097365 NPI number — JEFFERSON HOSPITAL ASSOCIATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFERSON HOSPITAL ASSOCIATION, 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:
1306097365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7500 DOLLARWAY RD
Provider Second Line Business Mailing Address:
SUITE 404
Provider Business Mailing Address City Name:
WHITE HALL
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71602-3027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-879-9595
Provider Business Mailing Address Fax Number:
870-879-9599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7500 DOLLARWAY RD
Provider Second Line Business Practice Location Address:
SUITE 404
Provider Business Practice Location Address City Name:
WHITE HALL
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71602-3027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-879-9595
Provider Business Practice Location Address Fax Number:
870-879-9599
Provider Enumeration Date:
10/08/2008

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 176263002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5G130 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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