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General NPI Number Information
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NPI Number | 1174656367
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Entity Type | Organization
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Legal Business Name | E.A. CONWAY MEDICAL CENTER
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 07/27/2010
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Provider Practice Location Address
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Address Line | 4864 JACKSON ST
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City | MONROE
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State | LA
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Zip | 71202-6400
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Country | US
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Telephone | 318-330-7000
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Fax | 318-675-5666
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Provider Business Mailing Address
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Address Line | 4864 JACKSON ST
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City | MONROE
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State | LA
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Zip | 71202-6400
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Country | US
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Telephone | 318-330-7000
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Fax | 318-675-5666
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Authorized Official
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Title or Position | DIRECTOR OF MANAGED CARE
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Name | MELANIE H SOTAK
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Credential | MHSA
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Telephone | 318-675-7737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 129
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License Number State | LA
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