Provider Demographics
NPI:1548031016
Name:JEFFERSON COMPREHENSIVE CARE SYSTEM, INC
Entity type:Organization
Organization Name:JEFFERSON COMPREHENSIVE CARE SYSTEM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/CAO
Authorized Official - Prefix:
Authorized Official - First Name:CHANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS MCFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-543-2380
Mailing Address - Street 1:PO BOX 1285
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71613-1285
Mailing Address - Country:US
Mailing Address - Phone:870-543-2311
Mailing Address - Fax:
Practice Address - Street 1:1400 MAIN ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-5036
Practice Address - Country:US
Practice Address - Phone:870-543-2300
Practice Address - Fax:870-535-4716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)