NPIMap

Organization Active NPI

Jefferson Hospital Association Inc

  • Family Medicine Physician
  • Pine Bluff, AR
National Provider Identifier
1831130764
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
JEFFERSON HOSPITAL ASSOCIATION INC
Practice address
4747 Dusty Lake Dr
Suite 202
Pine Bluff, AR 71603-8742
Phone
(870) 879-3517
Fax
(870) 879-6049
NPI assigned
Jun 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Narda Jo Smithey
Title
Office Coordinator
Phone
(870) 879-3517

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

4747 Dusty Lake Dr
Suite 202
Pine Bluff, AR 71603-8742

Mailing address

4747 Dusty Lake Dr
Suite 202
Pine Bluff, AR 71603-8742
Phone (870) 879-3517

Other identifiers 1

IdentifierTypeStateIssuer
CU0295OtherRAILROAD MEDICARE

Other names 1

  • Watson Chapel Family Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Jefferson Regional Med15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1831130764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4747 DUSTY LAKE DR",
            "address_2": "SUITE 202",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716038742",
            "telephone_number": "870-879-3517",
            "fax_number": "870-879-6049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4747 DUSTY LAKE DR",
            "address_2": "SUITE 202",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716038742",
            "telephone_number": "870-879-3517",
            "fax_number": "870-879-6049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON HOSPITAL ASSOCIATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "SMITHEY",
        "authorized_official_first_name": "NARDA",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "OFFICE COORDINATOR",
        "authorized_official_telephone_number": "870-879-3517"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CU0295",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Watson Chapel Family 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 Apr 20, 2008; 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.