Healthcare Provider Details

I. General information

NPI: 1780995373
Provider Name (Legal Business Name): CONWAY HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 BELL ST
CONWAY SC
29526-4113
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 843-488-2111
  • Fax: 843-488-2112
Mailing address:
  • Phone: 843-234-6946
  • Fax: 843-234-6990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

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