NPIMap

Organization Active NPI

Jefferson Hospital Association, Inc.

  • Health Maintenance Organization
  • Pine Bluff, AR
National Provider Identifier
1821021379
Registry record updated Jan 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
License
E2787 Issued in AR
Legal business name
JEFFERSON HOSPITAL ASSOCIATION, INC.
Practice address
1609 W 40TH Ave
Suite 207
Pine Bluff, AR 71603-6319
Phone
(870) 534-2348
Fax
(870) 850-6816
NPI assigned
Jul 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Walter Johnson
Title
Ceo
Phone
(870) 541-7269

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X E2787 AR Primary

Addresses

Primary practice location

1609 W 40TH Ave
Suite 207
Pine Bluff, AR 71603-6319

Mailing address

1609 W 40TH Ave
Suite 207
Pine Bluff, AR 71603-6319
Phone (870) 534-2348

Other identifiers 2

IdentifierTypeStateIssuer
5F782OtherARBLUE CROSS
165800002MedicaidAR

Other names 1

  • Rhuematology Clinic Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295481600000",
    "number": "1821021379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1609 W 40TH AVE",
            "address_2": "SUITE 207",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036319",
            "telephone_number": "870-534-2348",
            "fax_number": "870-850-6816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 W 40TH AVE",
            "address_2": "SUITE 207",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036319",
            "telephone_number": "870-534-2348",
            "fax_number": "870-850-6816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON HOSPITAL ASSOCIATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2011-01-20",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "WALTER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-541-7269",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "AR",
            "license": "E2787",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "5F782",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165800002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rhuematology Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pine Bluff, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.