Gastroenterology Associates of Southeast Arkansas, P.a.

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

C5353 Issued in AR

Legal business name

GASTROENTEROLOGY ASSOCIATES OF SOUTHEAST ARKANSAS, P.A.

Practice address

1609 W 40TH Ave
Suite 312
Pine Bluff, AR 71603-6329

Phone

(870) 534-3344

Fax

(870) 534-3517

NPI assigned

Jun 4, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. O T Gordon Jr., M.D.

Title

President

Phone

(870) 534-3344

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206316800000",
    "number": "1346289709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1609 W 40TH AVE",
            "address_2": "SUITE 312",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036329",
            "telephone_number": "870-534-3344",
            "fax_number": "870-534-3517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 W 40TH AVE",
            "address_2": "SUITE 312",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036329",
            "telephone_number": "870-534-3344",
            "fax_number": "870-534-3517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTROENTEROLOGY ASSOCIATES OF SOUTHEAST ARKANSAS, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2008-03-24",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "O",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "870-534-3344",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "AR",
            "license": "C5353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5C989",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "DB2069",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Medical Specialty Clinic/Center in Pine Bluff, AR
• Providers in Pine Bluff, AR by specialty
• Medical Specialty Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.