04D1050345 CLIA NUMBER - HARRISON SURGERY CENTER, LLC

Laboratory Demographics

  • CLIA Code: 04D1050345
  • Facility Name: HARRISON SURGERY CENTER, LLC
  • Facility Address: 2943 HWY 62 SW
    MOUNTAIN HOME, AR
    ZIP 72653
  • Facility Phone: 870 741-9700
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: KENNETH M. KILGORE
  • NPI Number: 1740398445
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D1050345
LAB Type Ambulatory Surgery Center
Facility Name HARRISON SURGERY CENTER, LLC
Street 2943 HWY 62 SW
City MOUNTAIN HOME
State AR
ZIP 72653
Phone 870 741-9700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/1/2024
Certificate Expiration Date 1/31/2026
Facility Type Ambulatory Surgery Center
Lab Director KENNETH M. KILGORE

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This page was last updated on: 9/29/2025