Provider Demographics
NPI:1740398445
Name:HARRISON SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:HARRISON SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MENSCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-424-4900
Mailing Address - Street 1:2943 HIGHWAY 62 W
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-6535
Mailing Address - Country:US
Mailing Address - Phone:870-424-3838
Mailing Address - Fax:870-424-3938
Practice Address - Street 1:2943 HIGHWAY 62 W
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-6535
Practice Address - Country:US
Practice Address - Phone:870-424-3838
Practice Address - Fax:870-424-3938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4367261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARAR4367OtherAR DEPT OF HEALTH LIC
11067Medicare PIN