Healthcare Provider Details

I. General information

NPI: 1487122669
Provider Name (Legal Business Name): CONWAY CARDIOVASCULAR SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 UNITED DR STE 120
CONWAY AR
72032-7826
US

IV. Provider business mailing address

650 UNITED DR STE 300
CONWAY AR
72032-7002
US

V. Phone/Fax

Practice location:
  • Phone: 501-205-8389
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES THOMAS
Title or Position: MD
Credential:
Phone: 501-205-8389