Organization
JEFFERSON HOSPITAL ASSOCIATION
Active
Other names
INTERNAL MEDICINE SPECIALIST
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRENNA RENEE JACKSON (DIRECTOR OF CLINICS)
(870) 541-7220
Entity
Organization
Contact information
Practice address
4201 S MULBERRY ST, PINE BLUFF, AR 71603-7016
(870) 541-7220
(870) 541-8769
Mailing address
4201 S MULBERRY ST, PINE BLUFF, AR 71603-7016
(870) 541-7220
(870) 541-8769
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163167002
—
AR
01
—
5F637
BLUE CROSS BLUE SHEILD
AR
01
—
DF8389
RAILROAD MEDICARE
AR
Enumeration date
10/27/2006
Last updated
07/02/2008
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