Basic Information
| Provider Information | |||||||||
| NPI: | 1710004338 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JEFFERSON MANAGEMENT SERVICE INC | ||||||||
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| OtherOrganizationName: | SHERIDAN MEDICAL ASSOCIATION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 W 40TH AVE | ||||||||
| Address2: | ATTN BRENNA JACKSON | ||||||||
| City: | PINE BLUFF | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716036301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705417220 | ||||||||
| FaxNumber: | 8705418769 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 OPPORTUNITY DR | ||||||||
| Address2: | ATTN TRACY HARRINGTON | ||||||||
| City: | SHERIDAN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721509185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709429833 | ||||||||
| FaxNumber: | 8709429837 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 09/24/2007 | ||||||||
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| AuthorizedOfficialLastName: | ATKINSON | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 8705417269 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.