Organization
JEFFERSON HOSPITAL ASSOCIATION, INC.
Active
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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