Healthcare Provider Details

I. General information

NPI: 1962617241
Provider Name (Legal Business Name): CONWAY HEMATOLOGY ONCOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 SALEM RD STE 4
CONWAY AR
72034-6133
US

IV. Provider business mailing address

350 SALEM RD STE 4
CONWAY AR
72034
US

V. Phone/Fax

Practice location:
  • Phone: 501-327-2995
  • Fax:
Mailing address:
  • Phone: 501-327-9995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC8494
License Number StateAR

VIII. Authorized Official

Name: SUE TSUDA
Title or Position: OWNER PARTNER
Credential: MD
Phone: 501-327-2995