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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