Organization
JEFFERSON HOSPITAL ASSOCIATION, INC.
Active
Other names
ENDOCRINOLOGY OF SOUTH ARKANSAS
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER JOHNSON (CEO)
(870) 541-7269
Entity
Organization
Contact information
Practice address
7500 DOLLARWAY RD, SUITE 404, WHITE HALL, AR 71602-3027
(870) 879-9595
(870) 879-9599
Mailing address
7500 DOLLARWAY RD, SUITE 404, WHITE HALL, AR 71602-3027
(870) 879-9595
(870) 879-9599
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
176263002
—
AR
01
—
5G130
BLUE CROSS BLUE SHIELD
AR
Enumeration date
10/08/2008
Last updated
01/21/2011
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