Organization
ARKANSAS SURGERY AND ENDOSCOPY CENTER, INC
Active
Other names
ASEC
Organization subpart
No
Provider details
NPI number
Authorized official
AHMED SAMAD (CEO)
(870) 692-0316
Entity
Organization
Contact information
Practice address
4800 HAZEL STREET, PINE BLUFF, AR 71603
(870) 536-4800
(870) 534-5535
Mailing address
PO BOX 925, PINE BLUFF, AR 71613
(870) 536-4800
(870) 534-5535
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
R4495
AR
261QE0800X
Endoscopy Clinic/Center
R4495
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11004
BLUE CROSS BLUE SHIELD
AR
05
—
128777128
—
AR
01
—
490002996
RAILROAD MEDICARE
—
01
—
5938123
AETNA
—
01
—
6800006
UNITED HEALTHCARE
—
Enumeration date
03/23/2006
Last updated
09/22/2021
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