Healthcare Provider Details

I. General information

NPI: 1285646083
Provider Name (Legal Business Name): CONWAY HOSPITAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 PROFESSI PK DR
CONWAY SC
29526-8964
US

IV. Provider business mailing address

STE 104 4728 JENN DRIVE
MYRTLE BEACH SC
29577-5714
US

V. Phone/Fax

Practice location:
  • Phone: 843-247-2999
  • Fax: 843-347-4746
Mailing address:
  • Phone: 843-236-8888
  • Fax: 843-236-5088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number20362
License Number StateSC

VIII. Authorized Official

Name: DR. JOHN HUGGINS
Title or Position: MD
Credential: MD
Phone: 843-347-2999