# JEFFERSON HOSPITAL ASSN, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** South Arkansas Cardiovascular Surgery Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982940433
- **Authorized official:** WALTER E. JOHNSON (CEO)
- **Authorized official phone:** (870) 541-7269

## Contact information

- **Practice address:** 1609 W 40TH AVE, SUITE 403, PINE BLUFF, AR 71603-6319
- **Practice address phone:** (870) 541-0668
- **Practice address fax:** (870) 541-0083
- **Mailing address:** PO BOX 2320, PINE BLUFF, AR 71613-2320
- **Mailing address phone:** (870) 541-5981
- **Mailing address fax:** (870) 541-8730

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | C6122 | AR | Yes |

## Other

- **Enumeration date:** 01/02/2013
- **Last updated:** 03/19/2015