Organization
JEFFERSON SURGERY CENTER PLLC
Active
Other names
JHA Ambulatory Surgery Center, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CRYSTAL R BOHANNAN CPA (ADMINISTRATOR)
(870) 541-3640
Entity
Organization
Contact information
Practice address
1609 W 40TH AVE, JRMC PROFESSIONAL CENTER, SUITE 103, PINE BLUFF, AR 71603-6329
(870) 541-3636
(870) 541-3639
Mailing address
1609 W 40TH AVE, JRMC PROFESSIONAL CENTER, SUITE 103, PINE BLUFF, AR 71603-6329
(870) 541-3636
(870) 541-3639
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
AR3637
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135346128
—
AR
Enumeration date
05/27/2006
Last updated
08/26/2008
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