Healthcare Provider Details

I. General information

NPI: 1306166012
Provider Name (Legal Business Name): CONWAY HOSPITAL COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 CREEL ST
CONWAY SC
29527-5018
US

IV. Provider business mailing address

PO BOX 2180
CONWAY SC
29528-2180
US

V. Phone/Fax

Practice location:
  • Phone: 843-248-4414
  • Fax: 843-248-3781
Mailing address:
  • Phone: 843-234-5139
  • Fax: 843-234-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number10578
License Number StateSC

VIII. Authorized Official

Name: WARREN C RATLEY
Title or Position: PRESIDENT
Credential:
Phone: 843-234-5139