Healthcare Provider Details

I. General information

NPI: 1659522076
Provider Name (Legal Business Name): HARRISON DIALYSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 GLADDEN ST
HARRISON AR
72601-2236
US

IV. Provider business mailing address

1409 GLADDEN ST
HARRISON AR
72601-2236
US

V. Phone/Fax

Practice location:
  • Phone: 870-204-6683
  • Fax: 870-204-6686
Mailing address:
  • Phone: 870-204-6683
  • Fax: 870-204-6686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIE A WILLIAMS
Title or Position: ADMINISTRATOR
Credential:
Phone: 417-334-8288