=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942510714
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONWAY FAMILY MEDICAL CARE PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2010
-----------------------------------------------------
Last Update Date | 10/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3650 COLLEGE AVE
-----------------------------------------------------
City | CONWAY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72034-7272
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-327-6900
-----------------------------------------------------
Fax | 501-327-3690
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1367
-----------------------------------------------------
City | CONWAY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72033-1367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-327-6900
-----------------------------------------------------
Fax | 501-327-3690
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DON MICHAEL CARTER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 501-327-6900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | C-5934
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------