Provider Demographics
NPI:1922068295
Name:ARKANSAS SURGERY AND ENDOSCOPY CENTER, INC
Entity Type:Organization
Organization Name:ARKANSAS SURGERY AND ENDOSCOPY CENTER, INC
Other - Org Name:ASEC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-692-0316
Mailing Address - Street 1:PO BOX 925
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71613
Mailing Address - Country:US
Mailing Address - Phone:870-536-4800
Mailing Address - Fax:870-534-5535
Practice Address - Street 1:4800 HAZEL STREET
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603
Practice Address - Country:US
Practice Address - Phone:870-536-4800
Practice Address - Fax:870-534-5535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR4495261QA1903X, 261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
490002996OtherRAILROAD MEDICARE
5938123OtherAETNA
AR128777128Medicaid
AR11004OtherBLUE CROSS BLUE SHIELD
6800006OtherUNITED HEALTHCARE
=========30OtherQUAL CHOICE
AR128777128Medicaid