Healthcare Provider Details

I. General information

NPI: 1922068295
Provider Name (Legal Business Name): ARKANSAS SURGERY AND ENDOSCOPY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 HAZEL STREET
PINE BLUFF AR
71603
US

IV. Provider business mailing address

PO BOX 925
PINE BLUFF AR
71613
US

V. Phone/Fax

Practice location:
  • Phone: 870-536-4800
  • Fax: 870-534-5535
Mailing address:
  • Phone: 870-536-4800
  • Fax: 870-534-5535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License NumberR4495
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberR4495
License Number StateAR

VIII. Authorized Official

Name: AHMED SAMAD
Title or Position: CEO
Credential:
Phone: 870-692-0316