Healthcare Provider Details

I. General information

NPI: 1063415891
Provider Name (Legal Business Name): HARRISON SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 SAWGRASS PT
HARRISON AR
72601-3072
US

IV. Provider business mailing address

105 SAWGRASS PT
HARRISON AR
72601-3072
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-9700
  • Fax:
Mailing address:
  • Phone: 870-741-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberAR4264
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLES MENSCHIK
Title or Position: ADMINISTRATOR
Credential:
Phone: 870-424-4900