MEDICARE: ARKANSAS PEDIATRICS OF CONWAY, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MC1605	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477516417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARKANSAS PEDIATRICS OF CONWAY, PA

Provider Business Mailing Address
First Line	:	PO BOX 1210
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72033-1210
Country	:	US
Telephone Number	:	501-329-1800
Fax Number	:	501-329-2507

Provider Business Practice Location Address
First Line	:	2710 COLLEGE AVE
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-6141
Country	:	US
Telephone Number	:	501-329-1800
Fax Number	:	501-329-2507

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. DONNA M. STRICKLAND
Credential	:
Telephone Number	:	501-329-1800

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	10/07/2021

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