Healthcare Provider Details

I. General information

NPI: 1831721570
Provider Name (Legal Business Name): SARC BY HSI PINE BUFF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 S HAZEL ST
PINE BLUFF AR
71603-7836
US

IV. Provider business mailing address

7200 S HAZEL ST
PINE BLUFF AR
71603-7836
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-2900
  • Fax: 870-534-9726
Mailing address:
  • Phone: 870-534-2900
  • Fax: 870-534-9726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SADEEM MAHMOOD
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 870-534-2900