Healthcare Provider Details

I. General information

NPI: 1336509819
Provider Name (Legal Business Name): ASC ANESTHESIA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 S HAZEL ST
PINE BLUFF AR
71603-6860
US

IV. Provider business mailing address

PO BOX 505338
SAINT LOUIS MO
63150-5388
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-5533
  • Fax: 870-534-5535
Mailing address:
  • Phone: 941-360-1566
  • Fax: 941-358-9818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: SYED SAMAD
Title or Position: OWNER
Credential: MD
Phone: 941-360-1566