Provider Demographics
NPI:1659522076
Name:HARRISON DIALYSIS LLC
Entity Type:Organization
Organization Name:HARRISON DIALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-334-8288
Mailing Address - Street 1:1409 GLADDEN ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2236
Mailing Address - Country:US
Mailing Address - Phone:870-204-6683
Mailing Address - Fax:870-204-6686
Practice Address - Street 1:1409 GLADDEN ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2236
Practice Address - Country:US
Practice Address - Phone:870-204-6683
Practice Address - Fax:870-204-6686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1659522076Medicaid
AR1659522076OtherBLUE CROSS
AR176925134Medicaid
AR176925134Medicaid