Organization
JEFFERSON REGIONAL ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRYAN G JACKSON (CFO)
(870) 541-7370
Entity
Organization
Contact information
Practice address
1600 W 40TH AVE, PINE BLUFF, AR 71603-6301
(870) 541-7370
(870) 541-7665
Mailing address
1600 W 40TH AVE, PINE BLUFF, AR 71603-6301
(870) 541-7370
(870) 541-7665
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
10/12/2018
Last updated
10/12/2018
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