JEFFERSON COMPREHENSIVE CARE SYSTEM INC NPI 1053571711

NPI Information

NPI: 1053571711
Provider Name: JEFFERSON COMPREHENSIVE CARE SYSTEM INC

Doing Business As: JCCSI CROSS OVER

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
1101 TENNSSEE
PINE BLUFF, AR
ZIP 71601
Phone: (870) 543-2380
Get Directions

JEFFERSON COMPREHENSIVE CARE SYSTEM INC is a federally qualified health center (fqhc) clinic center in Pine Bluff, AR. JEFFERSON COMPREHENSIVE CARE SYSTEM INC NPI is 1053571711. The provider is registered as an organization entity type.
The provider Is Doing Business As Jccsi Cross Over.

The provider's business location address is:

1101 TENNSSEE
PINE BLUFF, AR
ZIP 71601
Phone: (870) 543-2380
Fax: (870) 535-4716

The provider's authorized official is Larnell W Davis .
The authorized official title is Executive Director and has the following contact phone number (870) 543-2380.

The enumeration date for this NPI number is 6/16/2008 and was last updated on 6/16/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	122636741	MEDICAID	ARKANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »