Organization
JEFFERSON HOSPITAL ASSOCIATION, INC
Active
Organization
JEFFERSON HOSPITAL ASSOCIATION, INC
Active
Other names
Cardiology Associates
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WALTER JOHNSON (CEO)
(870) 541-7269
Entity
Organization
Contact information
Practice address
1601 W 40TH, SUITE 301, PINE BLUFF, AR 71603
(870) 541-7220
Mailing address
1601 W 40TH, SUITE 301, PINE BLUFF, AR 71603
(870) 541-4285
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
E-4501
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163127002
—
AR
01
—
5F630
BCBS
AR
01
—
DF4052
RAILROAD MEDICARE
AR
Enumeration date
07/19/2006
Last updated
03/18/2020
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