Organization
JEFFERSON COMPREHENSIVE CARE SYSTEM INC
Active
Organization
JEFFERSON COMPREHENSIVE CARE SYSTEM INC
Active
Other names
JCCSI Breast Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARNELL DAVIS (EXECUTIVE DIRECTOR)
(870) 543-2380
Entity
Organization
Contact information
Practice address
1101 TENNESSEE ST, PINE BLUFF, AR 71601-5801
(870) 543-2380
(870) 535-4716
Mailing address
PO BOX 1285, PINE BLUFF, AR 71613-1285
(870) 543-2380
(870) 535-4716
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
770019849
—
AR
Enumeration date
06/06/2008
Last updated
06/06/2008
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