Provider Demographics
NPI: | 1932157674 |
---|---|
Name: | JEFFERSON HOSPITAL ASSOCIATION, INC |
Entity Type: | Organization |
Organization Name: | JEFFERSON HOSPITAL ASSOCIATION, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | COO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | PETER |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | AUSTIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 870-541-7100 |
Mailing Address - Street 1: | PO BOX 2650 |
Mailing Address - Street 2: | |
Mailing Address - City: | PINE BLUFF |
Mailing Address - State: | AR |
Mailing Address - Zip Code: | 71613-2650 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 870-541-7211 |
Mailing Address - Fax: | 870-541-4297 |
Practice Address - Street 1: | 1601 W 40TH AVE |
Practice Address - Street 2: | SUITE 301 |
Practice Address - City: | PINE BLUFF |
Practice Address - State: | AR |
Practice Address - Zip Code: | 71603-6319 |
Practice Address - Country: | US |
Practice Address - Phone: | 870-879-3007 |
Practice Address - Fax: | 870-879-3008 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-05 |
Last Update Date: | 2023-07-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | Group - Multi-Specialty |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 207VX0000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics | Group - Multi-Specialty |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AR | 152571002 | Medicaid | |
AR | 152571002 | Medicaid |