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Organization
JEFFERSON HOSPITAL ASSOCIATION INC
Active
Organization
JEFFERSON HOSPITAL ASSOCIATION INC
Active
Other names
Jefferson Regional Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KRISTEN JADE DAVIS (DIRECTOR OF REIMBURSEMENT)
(870) 541-7173
Entity
Organization
Contact information
Practice address
1600 W. 40TH AVENUE, PINE BLUFF, AR 71603-6301
(870) 541-7100
(870) 541-7964
Mailing address
1600 W. 40TH AVENUE, PINE BLUFF, AR 71603-6301
(870) 541-7100
(870) 541-7966
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
—
—
273Y00000X
Rehabilitation Hospital Unit
AR4213
AR
282N00000X
General Acute Care Hospital
Primary
AR4213
AR
282N00000X
General Acute Care Hospital
—
—
314000000X
Skilled Nursing Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040071
MEDICARE PART A
AR
01
—
045307
MEDICARE PART A
AR
01
—
04S071
MEDICARE PART A
AR
01
—
10071
BLUE CROSS PROVIDER #
AR
05
—
102916105
—
AR
05
—
103078002
—
AR
01
—
15307
BLUE CROSS SNF PROVIDER #
AR
01
—
5000023
UNITED HEALTHCARE
AR
Enumeration date
05/20/2006
Last updated
10/21/2020
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