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General NPI Number Information
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NPI Number | 1922068295
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Entity Type | Organization
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Legal Business Name | ARKANSAS SURGERY AND ENDOSCOPY CENTER, INC
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 4800 HAZEL STREET
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City | PINE BLUFF
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State | AR
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Zip | 71603
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Country | US
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Telephone | 870-536-4800
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Fax | 870-534-5535
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Provider Business Mailing Address
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Address Line | PO BOX 925
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City | PINE BLUFF
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State | AR
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Zip | 71613
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Country | US
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Telephone | 870-536-4800
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Fax | 870-534-5535
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Authorized Official
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Title or Position | CEO
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Name | AHMED SAMAD
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Credential |
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Telephone | 870-692-0316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number | R4495
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | R4495
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License Number State | AR
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