Organization
JEFFERSON HOSPITAL ASSOCIATION, INC.
Active
Other names
Rhuematology Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WALTER JOHNSON (CEO)
(870) 541-7269
Entity
Organization
Contact information
Practice address
1609 W 40TH AVE, SUITE 207, PINE BLUFF, AR 71603-6319
(870) 534-2348
(870) 850-6816
Mailing address
1609 W 40TH AVE, SUITE 207, PINE BLUFF, AR 71603-6319
(870) 534-2348
(870) 850-6816
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
E2787
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165800002
—
AR
01
—
5F782
BLUE CROSS
AR
Enumeration date
07/08/2006
Last updated
01/20/2011
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