Provider Demographics
NPI:1235179581
Name:JEFFERSON HOSPITAL ASSOCIATION, INC.
Entity Type:Organization
Organization Name:JEFFERSON HOSPITAL ASSOCIATION, INC.
Other - Org Name:JEFFERSON HOSPITALIST SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-850-6053
Mailing Address - Street 1:1600 W 40TH AVE
Mailing Address - Street 2:ATTN: HOSPITALIST PROGRAM
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6301
Mailing Address - Country:US
Mailing Address - Phone:870-850-6053
Mailing Address - Fax:870-850-6482
Practice Address - Street 1:1600 W 40TH AVE
Practice Address - Street 2:ATTN: HOSPITALIST PROGRAM
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6301
Practice Address - Country:US
Practice Address - Phone:870-850-6053
Practice Address - Fax:870-850-6482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR171969102Medicaid
AR5F391Medicare PIN