Provider Demographics
NPI:1962753574
Name:JEFFERSON HOSPITAL ASSN, INC.
Entity type:Organization
Organization Name:JEFFERSON HOSPITAL ASSN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CBO DIRECTOR PRACTICE MANAGEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-541-5981
Mailing Address - Street 1:PO BOX 2320
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71613-2320
Mailing Address - Country:US
Mailing Address - Phone:870-541-4981
Mailing Address - Fax:870-541-8769
Practice Address - Street 1:1609 W 40TH AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6319
Practice Address - Country:US
Practice Address - Phone:870-541-5981
Practice Address - Fax:870-541-8769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty