MEDICARE: ARKANSAS ENDOSCOPY CENTER, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972574200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARKANSAS ENDOSCOPY CENTER, P.A.

Provider Business Mailing Address
First Line	:	9501 LILE DR
Second Line	:	SUITE 100
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6225
Country	:	US
Telephone Number	:	501-224-9100
Fax Number	:	501-224-0420

Provider Business Practice Location Address
First Line	:	9501 LILE DR
Second Line	:	SUITE 100
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6225
Country	:	US
Telephone Number	:	501-224-9100
Fax Number	:	501-224-0420

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	RONALD D HARDIN
Credential	:	M.D.
Telephone Number	:	501-224-9100

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	11/02/2010

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