PINE BLUFF ENDOSCOPY CENTER, LLC (NPI# 1275541427) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275541427 |
| Entity Type | Organization |
| Organization Name | PINE BLUFF ENDOSCOPY CENTER, LLC |
| Practice Address |
1609 W 40th Ave Suite 312 Pine Bluff AR 71603-6319 |
| Practice Telephone | 8705342626 |
| Practice Fax Number | 8705343517 |
| Mailing Telephone | 8705342626 |
| Mailing Fax Number | 8705343517 |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2013-11-25 |
| Authorized Official Name | O.T. GORDON JR. (MANAGING MEMBER) |
| Authorized Official Telephone | 8705343344 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | Y |
| Parent Organization Name | GASTROENTEROLOGY ASSOCIATES OF SOUTHEAST ARKANSAS |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0800X |
Clinic/Center Specialization: Endoscopy |
AR4347 | AR | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | BLUE CROSS BLUE SHIELD | 11066 | 01 |
| AR | RAIL ROAD MEDICARE | P00355592 | 01 |
| AR | 161691128 | 05 |
| Street Address |
1609 W 40TH AVE SUITE 312 |
| City | PINE BLUFF |
| State | AR |
| Zip Code | 71603-6319 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407852734 | Amy Boast Cahill | Obstetrics & Gynecology | 1609 W 40th Ave, Ste 204, Pine Bluff, AR 71603-6367 | 2005-06-22 |
| 1851787089 | Katie Loetscher | Nurse Practitioner | 1609 W 40th Ave, #204, Pine Bluff, AR 71603-6319 | 2015-04-14 |
| 1578906152 | Torrance A Walker Md Pa | Preferred Provider Organization | 1609 W 40th Ave, Suite 201, Pine Bluff, AR 71603-6319 | 2013-04-12 |
| 1982940433 | Jefferson Hospital Assn, Inc. | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1609 W 40th Ave, Suite 403, Pine Bluff, AR 71603-6319 | 2013-01-02 |
| 1962753574 | Jefferson Hospital Assn, Inc. | Surgery | 1609 W 40th Ave, Suite 403, Pine Bluff, AR 71603-6319 | 2012-09-21 |
| 1275841306 | Jefferson Hospital Association, Inc. | Orthopaedic Surgery | 1609 W 40th Ave, Suite 501, Pine Bluff, AR 71603-6319 | 2010-09-23 |
| 1285865865 | Lisa A Bearden Md Pa | Clinic/Center | 1609 W 40th Ave, Suite 204, Pine Bluff, AR 71603-6319 | 2009-07-30 |
| 1316184815 | Charles A. Clark, Md, Pa | Orthopaedic Surgery | 1609 W 40th Ave, Suite 501, Pine Bluff, AR 71603-6319 | 2009-01-21 |
| 1770750176 | Roy Louis Burrell | Orthopaedic Surgery | 1609 W 40th Ave, Suite 501, Pine Bluff, AR 71603-6319 | 2008-05-14 |
| 1891975173 | Amy Boast Cahill, M.d., P.a. | Clinic/Center | 1609 W 40th Ave, Suite 204, Pine Bluff, AR 71603-6319 | 2007-11-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700445038 | Hannah Carter | Dentist | 3801 S Olive St, Pine Bluff, AR 71603 | 2019-06-11 |
| 1821544628 | Nauman Yunus Md Pa | Internal Medicine | 1600 West 40th Ave, Jefferson Regional Medical Center, Pine Bluff, AR 71603 | 2016-08-31 |
| 1407278120 | Arkansas Cancer Clinic Pa | Radiology | 7200 South Hazel Street, Pine Bluff, AR 71603 | 2014-01-15 |
| 1730515396 | Sharon Yvette Webb | Student in an Organized Health Care Education/Training Program | 2318 Kyle Street, Pine Bluff, AR 71603 | 2013-09-16 |
| 1477992733 | David Larry Byrd | Pharmacist | 5 Longmeadow, Pine Bluff, AR 71603 | 2013-06-20 |
| 1437400371 | Thomas Jordan Harper | Pharmacist | 2809 South Camden Road, Pine Bluff, AR 71603 | 2012-10-01 |
| 1992080469 | C&d Disability.inc | Early Intervention Provider Agency | 4806 W 9th Street, Pine Bluff, AR 71603 | 2011-10-17 |
| 1457645863 | Clifton G Roaf & Marvin Q Caudle | Dentist | 1310 South Linden Street, Pine Bluff, AR 71603 | 2011-06-02 |
| 1932402682 | Mary Campbell | Licensed Practical Nurse | 2302 W. 28th, Suite A, Pine Bluff, AR 71603 | 2010-12-17 |
| 1245468925 | Evan N Newbolt | Ophthalmology | 3805 West 28th Ave, Pine Bluff, AR 71603 | 2009-07-01 |
| Find all providers in zip 71603 | ||||
| Taxonomy Code | 261QE0800X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Endoscopy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922068295 | Arkansas Surgery and Endoscopy Center, Inc | Clinic/Center | 4800 Hazel Street, Pine Bluff, AR 71603 | 2006-03-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760096630 | Speech and Swallowing Specialists of Arkansas LLC | Clinic/Center | 557 Pleasant Valley Road, Calico Rock, AR 72519 | 2020-09-08 |
| 1093950925 | Batesville Endoscopy Center, LLC | Clinic/Center | 1700 Harrison St Ste S, Batesville, AR 72501-7315 | 2008-12-05 |
| 1265439632 | Conway Endoscopy Center, Inc. | Clinic/Center | 455 Hogan Ln, Conway, AR 72034-8201 | 2005-06-30 |
| City | PINE BLUFF |
| Zip Code | 71603 |
Please comment or provide details below to improve the information on PINE BLUFF ENDOSCOPY CENTER, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.