Jefferson Comprehensive Care System, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Rison, AR
NPI 1396941191 · NPPES record last updated Jul 20, 2007
Key facts
- NPI
- 1396941191
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- JEFFERSON COMPREHENSIVE CARE SYSTEM, INC
- Practice address
- 505 Sycamore
Rison, AR 71665 - Phone
- (870) 325-6255
- Fax
- (870) 325-6117
- NPI assigned
- Jun 27, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- JEFFERSON COMPREHENSIVE CARE SYSTEM, INC
Authorized official
- Name
- Mr. Larnell W Davis
- Title
- Executive Director
- Phone
- (870) 543-2380
Other NPIs on the same Medicare enrollment 7
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040603001458 | AR | Part B Supplier - Clinic/Group Practice | 5193634509 |
Receives reassigned benefits from 22 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Altheimer, AR; Redfield, AR; Pine Bluff, AR; North Little Rock, AR; Little Rock, AR; College Station, AR |
National Provider Directory
- Part of
- Pine Bluff Health Clinic
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
505 Sycamore
Rison, AR 71665
Mailing address
PO Box 1285
Pine Bluff, AR 71613-1285
Phone (870) 543-2380
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 122634749 | Medicaid | AR |
Other names
- Rison Center
Other providers in Rison, AR
- Tammy S Green
- Alexa Rae Hill
- Diana L. Hill
- Jade Holleman
- Brenda Joyce Jacobs
- Mainline Health Systems, Inc
- Mainline Health Systems, Inc.
- Christopher Austin Metcalf
- Blair Ashton Miller
- New Beginnings Behavioral Health Services
All providers in Rison, AR · Federally Qualified Health Center (FQHC) in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.