JEFFERSON COMPREHENSIVE CARE SYSTEM, INC (NPI# 1730385105) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730385105 |
| Entity Type | Organization |
| Organization Name | JEFFERSON COMPREHENSIVE CARE SYSTEM, INC |
| Other Organization Name | ALTHEIMER CENTER |
| Practice Address |
309 S Edline Altheimer AR 72004-8559 |
| Mailing Address |
Po Box 1285 Pine Bluff AR 71613-1285 |
| Practice Telephone | 8707668411 |
| Practice Fax Number | 8707668412 |
| Mailing Telephone | 8705432380 |
| Mailing Fax Number | 8705354716 |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2007-07-20 |
| Authorized Official Name | MR. LARNELL W DAVIS (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 8705432380 |
| Is Organization Subpart | Y |
| Parent Organization Name | JEFFERSON COMPREHENSIVE CARE SYSTEM, INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 122651749 | 05 |
| Other Name | Type Code |
|---|---|
| Altheimer Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003353111 | Jefferson Comprehensive Care System, Inc | Clinic/Center | 2525 Willow St, Suite # 1, North Little Rock, AR 72114-2213 | 2017-01-26 |
| 1396941191 | Jefferson Comprehensive Care System, Inc | Clinic/Center | 505 Sycamore, Rison, AR 71665 | 2007-06-27 |
| 1124224928 | Jefferson Comprehensive Care System, Inc | Clinic/Center | 113 W River Rd, Redfield, AR 72132 | 2007-06-27 |
| 1689870065 | Jefferson Comprehensive Care System, Inc | Clinic/Center | 1225 Dr Martin Luther King Dr, Little Rock, AR 72202-4743 | 2007-06-22 |
| 1154386597 | Jefferson Comprehensive Care System, Inc | Clinic/Center | 1101 Tennessee St, Pine Bluff, AR 71601-5801 | 2006-04-19 |
| 1932305737 | Jefferson Comprehensive Care System, Inc | Clinic/Center | 4206 Frazier Pike, College Station, AR 72053 | 2007-06-27 |
| 1194922849 | Jefferson Comprehensive Care System, Inc | Clinic/Center | 1100 N University Ave, Suite 125, Little Rock, AR 72207-6343 | 2007-06-27 |
| Street Address |
309 S EDLINE |
| City | ALTHEIMER |
| State | AR |
| Zip Code | 72004-8559 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114945052 | Karen K Mcpherson | Nurse Practitioner | 309 S Edline, Jefferson Comprehensive Care, Altheimer, AR 72004-8559 | 2006-07-18 |
| 1720284268 | Malinda Chadsey | Family Medicine | 309 S Edline, Altheimer, AR 72004-8559 | 2007-06-22 |
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.