MEDICARE: CONWAY HOSPITAL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner
2	208600000X	Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043977200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONWAY HOSPITAL, INC.

Provider Business Mailing Address
First Line	:	300 SINGLETON RIDGE RD
Second Line	:	ATTN PNS CREDENTIALING
City	:	CONWAY
State	:	SC
Zip	:	29526-9142
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2369 CYPRESS CIR
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29526-8921
Country	:	US
Telephone Number	:	843-347-3900
Fax Number	:	843-347-3930

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	MARY ELLEN ARTIOLI
Credential	:
Telephone Number	:	843-234-6946

Provider Enumeration Date	:	11/23/2021
Last Update Date	:	12/24/2025

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