Provider Demographics
NPI:1699946723
Name:HARRY R. DENISON, P.A.
Entity type:Organization
Organization Name:HARRY R. DENISON, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:DENISON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-352-2167
Mailing Address - Street 1:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:FORDYCE
Mailing Address - State:AR
Mailing Address - Zip Code:71742
Mailing Address - Country:US
Mailing Address - Phone:870-352-2167
Mailing Address - Fax:870-352-8883
Practice Address - Street 1:312 SPRING ST.
Practice Address - Street 2:
Practice Address - City:FORDYCE
Practice Address - State:AR
Practice Address - Zip Code:71742
Practice Address - Country:US
Practice Address - Phone:870-352-2167
Practice Address - Fax:870-352-8883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2050332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102066722Medicaid
AR102066722Medicaid
ART20220Medicare UPIN
AR0296640001Medicare NSC