| Jccsi Cross Over | |
|
1101 Tennssee Pine Bluff AR 71601 | |
| (870) 543-2380 | |
| (870) 535-4716 |
| Full Name | Jccsi Cross Over |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1101 Tennssee, Pine Bluff, Arkansas |
| Authorized Official Name and Position | Larnell W Davis (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8705432380 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jccsi Cross Over Po Box 1285 Pine Bluff AR 71613-1285 Ph: (870) 543-2380 | Jccsi Cross Over 1101 Tennssee Pine Bluff AR 71601 Ph: (870) 543-2380 |
| NPI Number | 1053571711 |
|---|---|
| Provider Enumeration Date | 06/16/2008 |
| Last Update Date | 06/16/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053571711 | NPI | - | NPPES |
| 122636741 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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