| Jefferson Comprehensive Care System, Inc | |
|
1101 Tennessee St Pine Bluff AR 71601-5801 | |
| (870) 543-2380 | |
| (870) 535-4716 |
| Full Name | Jefferson Comprehensive Care System, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1101 Tennessee St, Pine Bluff, Arkansas |
| Authorized Official Name and Position | Larnell W Davis (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8705432380 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jefferson Comprehensive Care System, Inc Po Box 1285 Pine Bluff AR 71613-1285 Ph: (870) 543-2380 | Jefferson Comprehensive Care System, Inc 1101 Tennessee St Pine Bluff AR 71601-5801 Ph: (870) 543-2380 |
| NPI Number | 1154386597 |
|---|---|
| Provider Enumeration Date | 04/19/2006 |
| Last Update Date | 07/20/2007 |
| Medicare PECOS PAC ID | 5193634509 |
|---|---|
| Medicare Enrollment ID | O20040603001458 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154386597 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Marcus Crouther |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770520819 PECOS PAC ID: 2769383587 Enrollment ID: I20040115000622 |
| Provider Name | Sherri L Diamond |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932100534 PECOS PAC ID: 8921091398 Enrollment ID: I20040403000302 |
| Provider Name | Manuel R Kelley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083670830 PECOS PAC ID: 1951338581 Enrollment ID: I20050725001216 |
| Provider Name | Kathy L Woods |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205011541 PECOS PAC ID: 5294866331 Enrollment ID: I20100706000378 |
| Provider Name | Linda G Cabine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932164084 PECOS PAC ID: 6204008865 Enrollment ID: I20111004000721 |
| Provider Name | Vunkisha Nash |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184978421 PECOS PAC ID: 5294970059 Enrollment ID: I20130327000040 |
| Provider Name | Michelle L Bagby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043692080 PECOS PAC ID: 1153637939 Enrollment ID: I20150825004966 |
| Provider Name | Carla D Devose |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164846119 PECOS PAC ID: 9830491091 Enrollment ID: I20160105000930 |
| Provider Name | Stephanie J Shaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811364995 PECOS PAC ID: 1254640584 Enrollment ID: I20160510002025 |
| Provider Name | Crystal Holmes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497203335 PECOS PAC ID: 3577844711 Enrollment ID: I20170103000405 |
| Provider Name | Yolanda C Jeffery |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487071031 PECOS PAC ID: 2961783782 Enrollment ID: I20170110000055 |
| Provider Name | Shanna Rahmaan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699226860 PECOS PAC ID: 7416229422 Enrollment ID: I20170824002647 |
| Provider Name | Christy N Reed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669073631 PECOS PAC ID: 3870981673 Enrollment ID: I20211028000206 |
| Provider Name | Uhronda D Reel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922315613 PECOS PAC ID: 7810387305 Enrollment ID: I20211123002285 |
| Provider Name | Javonnia K Copeland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992262802 PECOS PAC ID: 4284024258 Enrollment ID: I20211206001963 |
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