JEFFERSON SURGERY CENTER PLLC
Ambulatory Health in Pine Bluff, AR

License number
Arkansas AR3637
Category
Ambulatory Health
Type
Ambulatory Surgical
Owner
Name: MRS. CRYSTAL R BOHANNAN CPA
Title: ADMINISTRATOR
Phone: (870) 541-3640
Address
Address
1609 Ave Jrmc Professional Ctr SUITE 103, Pine Bluff, AR 71603
National Provider ID: 1710934542
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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JEFFERSON SURGERY CENTER PLLC

1600 W 40 Ave, Pine Bluff, AR 71603

Registration:
Feb 4, 1998
State ID:
100155695
Business type:
Limited Liability Company
Tax Preparer:
Jeremy Jeffery (Tax Preparer)
Agent:
Walter Johnson,1600 W 40 Ave, Pine Bluff, AR 71603 (Physical)
Filled under act:
Domestic LLC; 1003 of 1993

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