Provider Demographics
NPI:1710004338
Name:JEFFERSON MANAGEMENT SERVICE INC
Entity Type:Organization
Organization Name:JEFFERSON MANAGEMENT SERVICE INC
Other - Org Name:SHERIDAN MEDICAL ASSOCIATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-541-7269
Mailing Address - Street 1:1600 W 40TH AVE
Mailing Address - Street 2:ATTN BRENNA JACKSON
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6301
Mailing Address - Country:US
Mailing Address - Phone:870-541-7220
Mailing Address - Fax:870-541-8769
Practice Address - Street 1:21 OPPORTUNITY DR
Practice Address - Street 2:ATTN TRACY HARRINGTON
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-9185
Practice Address - Country:US
Practice Address - Phone:870-942-9833
Practice Address - Fax:870-942-9837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center