Organization
PINE BLUFF ENDOSCOPY CENTER, LLC
Active
Organization
PINE BLUFF ENDOSCOPY CENTER, LLC
Active
Parent organization
GASTROENTEROLOGY ASSOCIATES OF SOUTHEAST ARKANSAS
Organization subpart
Yes
Provider details
NPI number
Legal business name
GASTROENTEROLOGY ASSOCIATES OF SOUTHEAST ARKANSAS
Authorized official
O.T. GORDON JR. M.D. (MANAGING MEMBER)
(870) 534-3344
Entity
Organization
Contact information
Practice address
1609 W 40TH AVE, SUITE 312, PINE BLUFF, AR 71603-6319
(870) 534-2626
(870) 534-3517
Mailing address
1609 W 40TH AVE, SUITE 312, PINE BLUFF, AR 71603-6319
(870) 534-2626
(870) 534-3517
Taxonomy
Speciality
Code
Description
License number
State
261QE0800X
Endoscopy Clinic/Center
Primary
AR4347
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11066
BLUE CROSS BLUE SHIELD
AR
05
—
161691128
—
AR
01
—
P00355592
RAIL ROAD MEDICARE
AR
Enumeration date
08/04/2006
Last updated
11/25/2013
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