Healthcare Provider Details

I. General information

NPI: 1689928103
Provider Name (Legal Business Name): CONWAY HOSPITAL COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SINGLETON RIDGE RD
CONWAY SC
29526-9142
US

IV. Provider business mailing address

PO BOX 2180
CONWAY SC
29528-2180
US

V. Phone/Fax

Practice location:
  • Phone: 843-347-8347
  • Fax: 843-234-6977
Mailing address:
  • Phone: 843-234-5139
  • Fax: 843-234-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BRET A BARR
Title or Position: CFO
Credential:
Phone: 843-347-7111