# JEFFERSON HOSPITAL ASSOCIATION, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jefferson Regional Monticello Medical Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104587526
- **Authorized official:** SHAYLA ROBINSON (CORPORATE COMPLIANCE OFFICER)
- **Authorized official phone:** (870) 541-7395

## Contact information

- **Practice address:** 906 ROBERTS DRIVE, SUITE B, MONTICELLO, AR 71655-5724
- **Practice address phone:** (870) 367-1461
- **Mailing address:** PO BOX 2650, PINE BLUFF, AR 71613-2650

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/07/2022
- **Last updated:** 04/01/2022