Provider Demographics
NPI:1841235868
Name:JEFFERSON HOSPITAL ASSOCIATION, INC
Entity Type:Organization
Organization Name:JEFFERSON HOSPITAL ASSOCIATION, INC
Other - Org Name:JEFFERSON REGIONAL HEALTHWORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/CHIEF ADMIN OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-541-7141
Mailing Address - Street 1:4201 S MULBERRY ST STE A
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-7002
Mailing Address - Country:US
Mailing Address - Phone:870-536-6600
Mailing Address - Fax:870-541-8623
Practice Address - Street 1:4201 S MULBERRY ST STE A
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7002
Practice Address - Country:US
Practice Address - Phone:870-536-6600
Practice Address - Fax:870-534-1519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56802OtherBLUE CROSS BLUE SHIELD
ARCI2242OtherRAILROAD MEDICARE
ARCI2242OtherRAILROAD MEDICARE