NPIMap

Organization Active NPI

Harrison Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Harrison, AR
National Provider Identifier
1659522076
Registry record updated Jun 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
HARRISON DIALYSIS LLC
Practice address
1409 Gladden St
Harrison, AR 72601-2236
Phone
(870) 204-6683
Fax
(870) 204-6686
NPI assigned
Oct 3, 2008
Last updated
Jun 9, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Julie A Williams
Title
Administrator
Phone
(417) 334-8288

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X NU Primary

Addresses

Primary practice location

1409 Gladden St
Harrison, AR 72601-2236

Mailing address

1409 Gladden St
Harrison, AR 72601-2236
Phone (870) 204-6683

Other identifiers 3

IdentifierTypeStateIssuer
1659522076OtherARBLUE CROSS
1659522076MedicaidMO
176925134MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081112000383 AR Part A Provider - End-Stage Renal Disease Facility (ESRD) 0648339150 Practice locations: Harrison, AR

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Harrison DialysisCCN 042584
Overall star rating
1.0 of 5
Ownership
Profit
Certified
Mar 13, 2009
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
20

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D1091242Harrison Dialysis LLC1409 Gladden Street, Harrison, AR 72601Certificate of waiverOct 27, 2026

National Provider Directory

National Provider Directory

Locations

1409 Gladden St
Harrison, AR 72601
Phone (870) 204-6683

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244505600000",
    "number": "1659522076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1409 GLADDEN ST",
            "city": "HARRISON",
            "state": "AR",
            "postal_code": "726012236",
            "telephone_number": "870-204-6683",
            "fax_number": "870-204-6686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 GLADDEN ST",
            "city": "HARRISON",
            "state": "AR",
            "postal_code": "726012236",
            "telephone_number": "870-204-6683",
            "fax_number": "870-204-6686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARRISON DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-03",
        "last_updated": "2009-06-09",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "417-334-8288"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "1659522076",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1659522076",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "176925134",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Harrison, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.