Healthcare Provider Details

I. General information

NPI: 1740398445
Provider Name (Legal Business Name): HARRISON SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2943 HIGHWAY 62 W
MOUNTAIN HOME AR
72653-6535
US

IV. Provider business mailing address

2943 HIGHWAY 62 W
MOUNTAIN HOME AR
72653-6535
US

V. Phone/Fax

Practice location:
  • Phone: 870-424-3838
  • Fax: 870-424-3938
Mailing address:
  • Phone: 870-424-3838
  • Fax: 870-424-3938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberAR4367
License Number StateAR

VIII. Authorized Official

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