Healthcare Provider Details

I. General information

NPI: 1548573322
Provider Name (Legal Business Name): CONWAY HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8004 MYRTLE TRACE DR
CONWAY SC
29526-8945
US

IV. Provider business mailing address

300 SINGLETON RIDGE RD ATTENTION PATIENT ACCOUNTING
CONWAY SC
29526-9142
US

V. Phone/Fax

Practice location:
  • Phone: 843-234-8939
  • Fax: 843-234-8959
Mailing address:
  • Phone: 843-234-6946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY ELLEN ARTIOLI
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 843-234-6946