Provider Demographics
NPI:1225762867
Name:HARRISON FAMILY MEDICINE
Entity Type:Organization
Organization Name:HARRISON FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:903-748-6386
Mailing Address - Street 1:218 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:STAMPS
Mailing Address - State:AR
Mailing Address - Zip Code:71860-2816
Mailing Address - Country:US
Mailing Address - Phone:870-533-1300
Mailing Address - Fax:870-533-1303
Practice Address - Street 1:218 CHURCH ST
Practice Address - Street 2:
Practice Address - City:STAMPS
Practice Address - State:AR
Practice Address - Zip Code:71860-2816
Practice Address - Country:US
Practice Address - Phone:870-533-1300
Practice Address - Fax:870-533-1303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-11
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty