Healthcare Provider Details

I. General information

NPI: 1598227431
Provider Name (Legal Business Name): SURGERY CENTER OF CONWAY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 MAIN STREET, SUITE A
CONWAY SC
29526-3568
US

IV. Provider business mailing address

1A BURTON HILLS BLVD., ATTN: L&C DEPT. SUITE 300
NASHVILLE TN
37215-6153
US

V. Phone/Fax

Practice location:
  • Phone: 843-488-1895
  • Fax: 843-488-2898
Mailing address:
  • Phone: 615-263-4011
  • Fax: 615-234-1720

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: KATHERINE JUDKINS
Title or Position: VICE PRESIDENT
Credential:
Phone: 615-240-3770