MEDICARE: HARRISON SURGERY CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS0132X	Ophthalmologic Surgery Clinic/Center
2	261QA1903X	Ambulatory Surgical Clinic/Center	AR4264	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063415891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARRISON SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	105 SAWGRASS PT
Second Line	:
City	:	HARRISON
State	:	AR
Zip	:	72601-3072
Country	:	US
Telephone Number	:	870-741-9700
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 SAWGRASS PT
Second Line	:
City	:	HARRISON
State	:	AR
Zip	:	72601-3072
Country	:	US
Telephone Number	:	870-741-9700
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CHARLES MENSCHIK
Credential	:
Telephone Number	:	870-424-4900

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/19/2021

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